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General NPI Number Information
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NPI Number | 1437828076
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Entity Type | Individual
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Provider Name | SUZETTE MICHELE SHARP
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Gender | Female
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 109 THOMAS PL
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City | ARENA
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State | WI
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Zip | 53503-9660
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Country | US
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Telephone | 608-333-8229
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 GEORGENE ST
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City | DODGEVILLE
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State | WI
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Zip | 53533-2212
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Country | US
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Telephone | 608-425-8906
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Fax |
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 261746
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License Number State | WI
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