MEDICARE: SHARON D MITCHHART LPN

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	LPN0000059877	TN

General Provider Information

NPI Number	:	1417939299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON D MITCHHART LPN

Provider Business Mailing Address
First Line	:	345 24TH AVE N
Second Line	:	SUITE 103
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1520
Country	:	US
Telephone Number	:	615-321-9556
Fax Number	:	615-321-9544

Provider Business Practice Location Address
First Line	:	345 24TH AVE N
Second Line	:	SUITE 103
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1520
Country	:	US
Telephone Number	:	615-321-9556
Fax Number	:	615-321-9544

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	07/08/2007

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