Provider Demographics
NPI:1033110887
Name:ESPERSEN, SHARON L (ANP)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:L
Last Name:ESPERSEN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 MISSION ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-6222
Mailing Address - Country:US
Mailing Address - Phone:503-585-5585
Mailing Address - Fax:503-587-7823
Practice Address - Street 1:885 MISSION ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-6222
Practice Address - Country:US
Practice Address - Phone:503-585-5585
Practice Address - Fax:503-587-7823
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00032760363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000803Medicaid
OR500003014OtherRAILROAD MEDICARE
ORS45237Medicare UPIN
OR100719Medicare ID - Type Unspecified