Healthcare Provider Details

I. General information

NPI: 1467530139
Provider Name (Legal Business Name): SHARON R RAINER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 SANSOM ST. SUITE 239
PHILADELPHIA PA
19107-5004
US

IV. Provider business mailing address

1020 SANSOM ST SUITE 239
PHILADELPHIA PA
19107-5004
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6844
  • Fax: 215-955-2526
Mailing address:
  • Phone: 215-955-6844
  • Fax: 215-955-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NN09626100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberTP006706C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: