Provider Demographics
NPI:1093965774
Name:PICKETT, SHARON D
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:D
Last Name:PICKETT
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 1:8635 FIRESTONE BLVD.
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-0000
Mailing Address - Country:US
Mailing Address - Phone:562-862-8282
Mailing Address - Fax:562-862-8551
Practice Address - Street 1:8635 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5281
Practice Address - Country:US
Practice Address - Phone:562-862-8282
Practice Address - Fax:562-862-8551
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA506353OtherCALIFORNIA BOARD OR REGISTERED NURSING LICENSE
CA16400OtherNURSE PRACTITIONER LICENSE