MEDICARE: SHARON KAY CORRIVEAU 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	363L00000X	Nurse Practitioner	61098656	WA
2	163W00000X	Registered Nurse	61035484	WA

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	:	1568455087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON KAY CORRIVEAU NP

Provider Business Mailing Address
First Line	:	PO BOX 1244
Second Line	:
City	:	CLINTON
State	:	WA
Zip	:	98236-1244
Country	:	US
Telephone Number	:	703-380-2189
Fax Number	:

Provider Business Practice Location Address
First Line	:	8150 LOPEZ DR
Second Line	:
City	:	CLINTON
State	:	WA
Zip	:	98236-9236
Country	:	US
Telephone Number	:	703-380-2189
Fax Number	:

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	11/26/2023

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