Healthcare Provider Details

I. General information

NPI: 1649437823
Provider Name (Legal Business Name): SHARON KAY HYDO R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E VETERANS ST
TOMAH WI
54660-3105
US

IV. Provider business mailing address

W14721 OLD HIGHWAY 10
FAIRCHILD WI
54741-8843
US

V. Phone/Fax

Practice location:
  • Phone: 608-372-1176
  • Fax:
Mailing address:
  • Phone: 715-334-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number72850030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: