Provider Demographics
NPI:1083708531
Name:WILBUR, SHAREN MARY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHAREN
Middle Name:MARY
Last Name:WILBUR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1510 ORANGE AVENUE, UNIT 901
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-1499
Mailing Address - Country:US
Mailing Address - Phone:909-792-4931
Mailing Address - Fax:
Practice Address - Street 1:VA LOMA LINDA HEALTHCARE SYSTEM
Practice Address - Street 2:11201 BENTON STREET
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357
Practice Address - Country:US
Practice Address - Phone:800-741-8387
Practice Address - Fax:909-583-6723
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14064363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner