Healthcare Provider Details

I. General information

NPI: 1174797294
Provider Name (Legal Business Name): SHARON SUSAN FORLENZA-STEVENS RN,CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W CHESTNUT ST STE 6
HAZLETON PA
18201-6423
US

IV. Provider business mailing address

15 PUBLIC SQ SUITE 600
WILKES BARRE PA
18701-1702
US

V. Phone/Fax

Practice location:
  • Phone: 570-501-2941
  • Fax: 570-501-1194
Mailing address:
  • Phone: 570-826-1777
  • Fax: 570-823-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP001047G
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberSP001047G
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1007678420035
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1007678420033
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier1025994230001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 4
Identifier1025994230002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: