MEDICARE: GITANJALI SHARMA ACNP-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	363LA2100X	Acute Care Nurse Practitioner	5660172-4405	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497164180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GITANJALI SHARMA ACNP-BC

Provider Business Mailing Address
First Line	:	3668 S GILROY RD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-3825
Country	:	US
Telephone Number	:	801-673-5156
Fax Number	:

Provider Business Practice Location Address
First Line	:	3920 S 1100 E
Second Line	:	STE 250
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1213
Country	:	US
Telephone Number	:	801-308-8400
Fax Number	:	801-349-2849

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

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	03/10/2016

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