Provider Demographics
NPI:1013587021
Name:BASS, SHARON BELINDA (RN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:BELINDA
Last Name:BASS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 59TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1569
Mailing Address - Country:US
Mailing Address - Phone:510-689-9252
Mailing Address - Fax:
Practice Address - Street 1:571 59TH ST APT A
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1569
Practice Address - Country:US
Practice Address - Phone:510-689-9252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95142695163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA04196171OtherKAISER