Provider Demographics
NPI:1275534570
Name:SHARP, CAROL LYNN (RN / OGNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LYNN
Last Name:SHARP
Suffix:
Gender:F
Credentials:RN / OGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S LAKEVIEW ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-2371
Mailing Address - Country:US
Mailing Address - Phone:269-659-4646
Mailing Address - Fax:269-651-2210
Practice Address - Street 1:600 S LAKEVIEW ST
Practice Address - Street 2:SUITE 207
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-2371
Practice Address - Country:US
Practice Address - Phone:269-659-4646
Practice Address - Fax:269-651-2210
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704155434363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008763580OtherBCBS
MI4205605Medicaid
MIOM96510Medicare ID - Type Unspecified