Provider Demographics
NPI:1174511943
Name:FELLION, SHARON L (RNC WHNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:FELLION
Suffix:
Gender:F
Credentials:RNC WHNP
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:LORRAINE
Other - Last Name:FELLION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:WHNP
Mailing Address - Street 1:3123 SHORE DR STE 201
Mailing Address - Street 2:WOMANS SPECIALTY CARE
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-4290
Mailing Address - Country:US
Mailing Address - Phone:715-735-6263
Mailing Address - Fax:715-735-5692
Practice Address - Street 1:3123 SHORE DR STE 201
Practice Address - Street 2:WOMANS SPECIALTY CARE
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4290
Practice Address - Country:US
Practice Address - Phone:715-735-6263
Practice Address - Fax:715-735-5692
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4707086166363L00000X
WI83033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI83033OtherLICENSE
500018073-WIOtherRR - MEDICARE
WI43939800Medicaid
MION42190OtherMEDICAID
S06833Medicare UPIN
001140165Medicare ID - Type Unspecified
MION42190OtherMEDICAID