Provider Demographics
NPI:1073036083
Name:FONTAINE, SHARA
Entity Type:Individual
Prefix:
First Name:SHARA
Middle Name:
Last Name:FONTAINE
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 1:9518 GENTRY SHADOWS LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4356
Mailing Address - Country:US
Mailing Address - Phone:832-428-9062
Mailing Address - Fax:
Practice Address - Street 1:9518 GENTRY SHADOWS LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4356
Practice Address - Country:US
Practice Address - Phone:832-428-9062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX732457163WG0000X, 163WM0102X, 163W00000X
251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn