Provider Demographics
NPI:1033451067
Name:EUBANKS, SHARON KAY (RN, LMT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:KAY
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PINCKNEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62274-1132
Mailing Address - Country:US
Mailing Address - Phone:618-357-3222
Mailing Address - Fax:
Practice Address - Street 1:202 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PINCKNEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62274-1132
Practice Address - Country:US
Practice Address - Phone:618-357-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-16
Last Update Date:2013-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.000865225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist