=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972900660
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | QUANISHA JEWEL SHARP LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/25/2014
-----------------------------------------------------
Last Update Date | 03/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 W JACKSON ST
-----------------------------------------------------
City | PAINESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44077-3212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-778-0050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4471 GRANADA BLVD APT 119
-----------------------------------------------------
City | WARRENSVILLE HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44128-4860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-778-0050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 164536
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number | 400780600708
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------