Healthcare Provider Details

I. General information

NPI: 1437146701
Provider Name (Legal Business Name): SHARON HOLLENKAMP CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 W PIERCE ST
CARLSBAD NM
88220-3553
US

IV. Provider business mailing address

2108 CALLE DE CODORNIZ
CARLSBAD NM
88220-4188
US

V. Phone/Fax

Practice location:
  • Phone: 505-887-4191
  • Fax:
Mailing address:
  • Phone: 505-887-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR48054
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: