Healthcare Provider Details

I. General information

NPI: 1376861302
Provider Name (Legal Business Name): SHARON ANN SHIRLEY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 RIO VISTA DR
FALLON NV
89406-5463
US

IV. Provider business mailing address

1001 RIO VISTA DR
FALLON NV
89406-5463
US

V. Phone/Fax

Practice location:
  • Phone: 775-423-3634
  • Fax:
Mailing address:
  • Phone: 775-423-3634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN12128
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: