Healthcare Provider Details

I. General information

NPI: 1407417751
Provider Name (Legal Business Name): SHARON PITRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 BRIDGEPORT WAY W
UNIVERSITY PLACE WA
98466-4201
US

IV. Provider business mailing address

1259 32ND PL NE
AUBURN WA
98002-2357
US

V. Phone/Fax

Practice location:
  • Phone: 253-200-3556
  • Fax:
Mailing address:
  • Phone: 253-833-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60960631
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: