Healthcare Provider Details

I. General information

NPI: 1679394928
Provider Name (Legal Business Name): SHARON VERONICA TERRY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 GRAND LAKE ESTATES DR
MONTGOMERY TX
77316-5413
US

IV. Provider business mailing address

9010 GRAND LAKE ESTATES DR
MONTGOMERY TX
77316-5413
US

V. Phone/Fax

Practice location:
  • Phone: 936-718-3496
  • Fax:
Mailing address:
  • Phone: 936-718-3496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number597178
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: