Provider Demographics
NPI:1063508703
Name:KIMBALL, SHARON (RNNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:RNNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 IVY ST
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-6126
Mailing Address - Country:US
Mailing Address - Phone:415-206-5638
Mailing Address - Fax:415-206-4562
Practice Address - Street 1:536 IVY ST
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-6126
Practice Address - Country:US
Practice Address - Phone:415-206-5638
Practice Address - Fax:415-206-4562
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA326484163WW0101X
CA326484/7362363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Not Answered363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MK1453365OtherDEA CERTIFICATION