Healthcare Provider Details

I. General information

NPI: 1407192818
Provider Name (Legal Business Name): SHARIS R WOLFRAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTITUTION AVE NE BUILDING 'D', INTERNAL MEDICINE
ALBUQUERQUE NM
87110-7613
US

IV. Provider business mailing address

8300 CONSTITUTION AVE NE BUILDING 'D', INTERNAL MEDICINE
ALBUQUERQUE NM
87110-7613
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-2200
  • Fax:
Mailing address:
  • Phone: 505-291-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR21525
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: