Provider Demographics
NPI:1184629891
Name:KLINGERMAN, SHARON K (NP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:K
Last Name:KLINGERMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NAVARRE PL
Mailing Address - Street 2:STE 6695
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1169
Mailing Address - Country:US
Mailing Address - Phone:800-860-8100
Mailing Address - Fax:
Practice Address - Street 1:100 NAVARRE PL
Practice Address - Street 2:STE 5550
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1169
Practice Address - Country:US
Practice Address - Phone:574-234-5123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000538A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200190960Medicaid
MI4828700Medicaid
IN216950OMedicare PIN
MI4828700Medicaid