Provider Demographics
NPI:1164002309
Name:MEADOWS, SHARMAINE
Entity Type:Individual
Prefix:
First Name:SHARMAINE
Middle Name:
Last Name:MEADOWS
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 1:1680 SUBURBAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-6632
Mailing Address - Country:US
Mailing Address - Phone:612-357-3241
Mailing Address - Fax:
Practice Address - Street 1:1680 SUBURBAN AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-6632
Practice Address - Country:US
Practice Address - Phone:612-357-3241
Practice Address - Fax:651-330-9400
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN172V00000X
251E00000X, 343900000X, 347C00000X, 347E00000X, 372600000X, 385H00000X
MN1103582253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No172V00000XOther Service ProvidersCommunity Health Worker
No251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
No372600000XNursing Service Related ProvidersAdult Companion
No385H00000XRespite Care FacilityRespite Care