Provider Demographics
NPI:1285043059
Name:WHITEFAWN, SHARON J
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:J
Last Name:WHITEFAWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 99
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-0099
Mailing Address - Country:US
Mailing Address - Phone:209-966-2000
Mailing Address - Fax:
Practice Address - Street 1:5362 LEMEE LANE
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-0099
Practice Address - Country:US
Practice Address - Phone:209-966-2000
Practice Address - Fax:209-966-8251
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator