Provider Demographics
NPI:1164644878
Name:MURNER, SHARON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:MURNER
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 1:5134 CRESCENT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45315-9678
Mailing Address - Country:US
Mailing Address - Phone:937-836-5248
Mailing Address - Fax:
Practice Address - Street 1:5134 CRESCENT RIDGE DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:OH
Practice Address - Zip Code:45315-9678
Practice Address - Country:US
Practice Address - Phone:937-836-5248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2506112374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2506112Medicaid