=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891870614
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON A REDERFORD ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 05/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3732 LAKESIDE DR STE 202
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89509-4519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-626-0974
-----------------------------------------------------
Fax | 775-470-6636
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3732 LAKESIDE DR STE 202
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89509-4519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-376-8274
-----------------------------------------------------
Fax | 775-470-6636
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN002438
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------