MEDICARE: ELIZABETH TAMBUDZAI SHARARA

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	164X00000X	Licensed Vocational Nurse	225894	TX

General Provider Information

NPI Number	:	1376043091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH TAMBUDZAI SHARARA

Provider Business Mailing Address
First Line	:	8001 S US HIGHWAY 75
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-5707
Country	:	US
Telephone Number	:	903-532-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	1328 GREENSBORO DR
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-8609
Country	:	US
Telephone Number	:	214-952-7484
Fax Number	:

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

Provider Enumeration Date	:	02/19/2018
Last Update Date	:	02/19/2018

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