Healthcare Provider Details

I. General information

NPI: 1922164888
Provider Name (Legal Business Name): SHARON HOUSE LPN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6970 RAMEY RD
CENTERBURG OH
43011-9645
US

IV. Provider business mailing address

113 MARITA DR
MOUNT VERNON OH
43050-2911
US

V. Phone/Fax

Practice location:
  • Phone: 740-625-5490
  • Fax:
Mailing address:
  • Phone: 740-397-5381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN 071199
License Number StateOH

VIII. Authorized Official

Name: SHARON DIANE HOUSE
Title or Position: LPN
Credential: LPN
Phone: 740-397-5381