MEDICARE: SHARON SUZETTE BATES NP-C

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	SP011493	PA

General Provider Information

NPI Number	:	1740560945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON SUZETTE BATES NP-C

Provider Business Mailing Address
First Line	:	286 BACON RUN RD
Second Line	:
City	:	CLARKSVILLE
State	:	PA
Zip	:	15322-6312
Country	:	US
Telephone Number	:	724-678-8309
Fax Number	:

Provider Business Practice Location Address
First Line	:	286 BACON RUN RD
Second Line	:
City	:	CLARKSVILLE
State	:	PA
Zip	:	15322-6312
Country	:	US
Telephone Number	:	724-678-8309
Fax Number	:

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

Provider Enumeration Date	:	08/19/2011
Last Update Date	:	08/19/2011

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