Provider Demographics
NPI:1003389412
Name:MCJAMES, SHARRON ROSHELLE
Entity Type:Individual
Prefix:
First Name:SHARRON
Middle Name:ROSHELLE
Last Name:MCJAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 MARYWELL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-1125
Mailing Address - Country:US
Mailing Address - Phone:314-304-9196
Mailing Address - Fax:
Practice Address - Street 1:1916 MARYWELL DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-1125
Practice Address - Country:US
Practice Address - Phone:314-304-9196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOH2080570303747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant