MEDICARE: SHARON LOUISE HEINRICH NP

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	163W00000X	Registered Nurse	148711	NC
2	363L00000X	Nurse Practitioner	200843	NC
3	363LF0000X	Family Nurse Practitioner	200843	NC

General Provider Information

NPI Number	:	1336162239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON LOUISE HEINRICH NP

Provider Business Mailing Address
First Line	:	PO BOX 3984
Second Line	:	GASTON HOSPICE
City	:	GASTONIA
State	:	NC
Zip	:	28054-0040
Country	:	US
Telephone Number	:	704-861-8405
Fax Number	:	704-865-0590

Provider Business Practice Location Address
First Line	:	258 E GARRISON BLVD
Second Line	:	GASTON HOSPICE
City	:	GASTONIA
State	:	NC
Zip	:	28054-0460
Country	:	US
Telephone Number	:	704-861-8405
Fax Number	:	704-865-0590

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/17/2012

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