MEDICARE: MRS. CAROL LYNN SHARP R.N. / OGNP

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	363LW0102X	Women's Health Nurse Practitioner	4704155434	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5008763580	OTHER	MI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275534570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL LYNN SHARP R.N. / OGNP

Provider Business Mailing Address
First Line	:	600 S LAKEVIEW ST
Second Line	:	SUITE 207
City	:	STURGIS
State	:	MI
Zip	:	49091-2371
Country	:	US
Telephone Number	:	269-659-4646
Fax Number	:	269-651-2210

Provider Business Practice Location Address
First Line	:	600 S LAKEVIEW ST
Second Line	:	SUITE 207
City	:	STURGIS
State	:	MI
Zip	:	49091-2371
Country	:	US
Telephone Number	:	269-659-4646
Fax Number	:	269-651-2210

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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