MEDICARE: CAMILLA SHARP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN.104541-MEDS	OH

General Provider Information

NPI Number	:	1225490832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLA SHARP

Provider Business Mailing Address
First Line	:	13418 SPARGUR LN
Second Line	:
City	:	HILLSBORO
State	:	OH
Zip	:	45133-8114
Country	:	US
Telephone Number	:	513-739-5116
Fax Number	:

Provider Business Practice Location Address
First Line	:	10554 SUCCESS LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45458-3658
Country	:	US
Telephone Number	:	937-619-3111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	03/23/2016

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