Healthcare Provider Details

I. General information

NPI: 1083898019
Provider Name (Legal Business Name): JAMIE MARIE SHARP CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE MARIE NEAL

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LAIDLEY ST
CHARLESTON WV
25301-1614
US

IV. Provider business mailing address

110 ROANE ST
CHARLESTON WV
25302-2334
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-0096
  • Fax: 304-342-4725
Mailing address:
  • Phone: 304-344-0096
  • Fax: 304-342-4725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number077831
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: