Healthcare Provider Details

I. General information

NPI: 1801921960
Provider Name (Legal Business Name): SHARON L ANDREATTA CFNP.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 CENTRAL PARK SQ
LOS ALAMOS NM
87544-4021
US

IV. Provider business mailing address

118 CENTRAL PARK SQ
LOS ALAMOS NM
87544-4021
US

V. Phone/Fax

Practice location:
  • Phone: 505-662-4798
  • Fax:
Mailing address:
  • Phone: 505-662-4798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR30557
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License NumberR30557
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01668
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: