Provider Demographics
NPI:1235537895
Name:ANDERSON, SHARRON ASHLEY (RT)
Entity Type:Individual
Prefix:
First Name:SHARRON
Middle Name:ASHLEY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:SHARRON
Other - Middle Name:ASHLEY
Other - Last Name:COUSIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:975 KIRMAN AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-0993
Mailing Address - Country:US
Mailing Address - Phone:775-785-7046
Mailing Address - Fax:
Practice Address - Street 1:975 KIRMAN AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-0993
Practice Address - Country:US
Practice Address - Phone:775-785-7046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV50579247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist