MEDICARE: MS. SHARON VALLEY PORTER MSN, APRN, FNP-BC

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	363LF0000X	Family Nurse Practitioner	AP05284	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2007004823	OTHER		ANCC FNP CERTIFICATION

General Provider Information

NPI Number	:	1346433893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARON VALLEY PORTER MSN, APRN, FNP-BC

Provider Business Mailing Address
First Line	:	5900 DOWDELL AVE UNIT 160
Second Line	:
City	:	ROHNERT PARK
State	:	CA
Zip	:	94928-4134
Country	:	US
Telephone Number	:	318-290-8305
Fax Number	:

Provider Business Practice Location Address
First Line	:	3841 BRICKWAY BLVD
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-8226
Country	:	US
Telephone Number	:	707-569-2300
Fax Number	:

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

Provider Enumeration Date	:	08/18/2007
Last Update Date	:	11/02/2021

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