Healthcare Provider Details

I. General information

NPI: 1366408171
Provider Name (Legal Business Name): SHARON RUTH BOTTOMLEY MSN, RN, ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROANOKE BOULEVARD
SALEM VA
24153-6404
US

IV. Provider business mailing address

1970 ROANOKE BOULEVARD
SALEM VA
24153-6404
US

V. Phone/Fax

Practice location:
  • Phone: 540-982-2463
  • Fax: 540-224-1937
Mailing address:
  • Phone: 540-982-2463
  • Fax: 540-224-1937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024145861
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024145861
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: