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General NPI Number Information
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NPI Number | 1265016992
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Entity Type | Organization
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Legal Business Name | SHARON R HASTING APN
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | 1639 N ALPINE RD STE 403
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City | ROCKFORD
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State | IL
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Zip | 61107-1440
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Country | US
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Telephone | 815-965-8505
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Fax | 815-965-8440
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Provider Business Mailing Address
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Address Line | 13216 E KRISE RD
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City | STOCKTON
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State | IL
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Zip | 61085-9403
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Country | US
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Telephone | 815-990-3276
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHARON R HASTING
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Credential | APRN-FPA
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Telephone | 815-990-3276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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