Healthcare Provider Details

I. General information

NPI: 1609111962
Provider Name (Legal Business Name): SHARON WINGATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 BUTTONWOOD ST
PERKASIE PA
18944
US

IV. Provider business mailing address

642 BUTTONWOOD ST
PERKASIE PA
18944
US

V. Phone/Fax

Practice location:
  • Phone: 267-261-5388
  • Fax:
Mailing address:
  • Phone: 267-261-5388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN09485L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License NumberPN094857L
License Number StatePA

VIII. Authorized Official

Name: SHARON LEE WINGATE
Title or Position: LPN
Credential:
Phone: 267-261-5388