Healthcare Provider Details

I. General information

NPI: 1063430411
Provider Name (Legal Business Name): SHARON JOLIVETTE RN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 CALEDONIA ST
LA CROSSE WI
54603-2514
US

IV. Provider business mailing address

1101 QUINCY ST
ONALASKA WI
54650-2340
US

V. Phone/Fax

Practice location:
  • Phone: 608-775-8380
  • Fax: 608-775-8385
Mailing address:
  • Phone: 608-775-8380
  • Fax: 608-775-8385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: