MEDICARE: SHARON STARR SURRATT RN

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	0001064706	VA

General Provider Information

NPI Number	:	1902936719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON STARR SURRATT RN

Provider Business Mailing Address
First Line	:	23 W MAIN ST
Second Line	:
City	:	LURAY
State	:	VA
Zip	:	22835-1230
Country	:	US
Telephone Number	:	540-743-4548
Fax Number	:	540-743-6067

Provider Business Practice Location Address
First Line	:	23 W MAIN ST
Second Line	:
City	:	LURAY
State	:	VA
Zip	:	22835-1230
Country	:	US
Telephone Number	:	540-743-4548
Fax Number	:	540-743-6067

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	07/08/2007

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