Healthcare Provider Details

I. General information

NPI: 1932247269
Provider Name (Legal Business Name): SHARON SHOCKLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 N GEORGE MASON DR
ARLINGTON VA
22205-3675
US

IV. Provider business mailing address

2919 1ST ST N
ARLINGTON VA
22201-1001
US

V. Phone/Fax

Practice location:
  • Phone: 703-228-4856
  • Fax: 703-228-5234
Mailing address:
  • Phone: 703-528-2342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number0001096778
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: