Healthcare Provider Details

I. General information

NPI: 1144352972
Provider Name (Legal Business Name): NINA MARIE SHARP INDEPENDANT PROVIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 TOWNSHIP ROAD 113
PEDRO OH
45659-9000
US

IV. Provider business mailing address

10418 STATE ROUTE 775
SCOTTOWN OH
45678-8947
US

V. Phone/Fax

Practice location:
  • Phone: 740-532-4785
  • Fax:
Mailing address:
  • Phone: 740-643-2872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number2592869
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: