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General NPI Number Information
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NPI Number | 1215420054
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Entity Type | Individual
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Provider Name | SHARON ANGELICA FOWLKES L.P.N.
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Gender | Female
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 5812 DUNKIRK ST
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City | PORTSMOUTH
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State | VA
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Zip | 23703-3128
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Country | US
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Telephone | 757-318-8407
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Fax | 757-673-3606
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Provider Business Mailing Address
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Address Line | 5812 DUNKIRK ST
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City | PORTSMOUTH
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State | VA
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Zip | 23703-3128
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Country | US
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Telephone | 757-318-8407
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Fax | 757-673-3606
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 0002079887
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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