Provider Demographics
NPI:1215002209
Name:TOBLER, SHARON B (RN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:B
Last Name:TOBLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 N 540 E
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-3772
Mailing Address - Country:US
Mailing Address - Phone:801-491-8587
Mailing Address - Fax:
Practice Address - Street 1:151 S UNIVERSITY AVE # 1900
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-4427
Practice Address - Country:US
Practice Address - Phone:801-851-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT210639-3102163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT73-00012OtherUNITED HEALTHCARE #
UT998877660009Medicaid
UTQM0000039389OtherALTIUS PROVIDER #
UTPR00489Medicaid
UT103003506102OtherSELECT HEALTH PROVIDER #
UT55102OtherPEHP PROVIDER #