Provider Demographics
NPI:1164034666
Name:MCDONOUGH, SHARON MARIE
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:MARIE
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-1405
Mailing Address - Country:US
Mailing Address - Phone:304-725-4044
Mailing Address - Fax:304-725-9500
Practice Address - Street 1:103 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1405
Practice Address - Country:US
Practice Address - Phone:304-725-4044
Practice Address - Fax:304-725-9500
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker