Healthcare Provider Details

I. General information

NPI: 1306581897
Provider Name (Legal Business Name): SHARON GRANTE OTWORTH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAO SCIOTO COUNTY, 411 2ND STREET
PORTSMOUTH OH
45662-3806
US

IV. Provider business mailing address

PO BOX 1525
PORTSMOUTH OH
45662-1525
US

V. Phone/Fax

Practice location:
  • Phone: 740-354-7545
  • Fax:
Mailing address:
  • Phone: 614-512-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number320754
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: