Provider Demographics
NPI:1295826154
Name:WOOTTEN, SHARI L (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHARI
Middle Name:L
Last Name:WOOTTEN
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 1:2512 WHEATON WAY STE A
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3303
Mailing Address - Country:US
Mailing Address - Phone:360-782-5700
Mailing Address - Fax:253-984-2049
Practice Address - Street 1:2512 WHEATON WAY STE A
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3303
Practice Address - Country:US
Practice Address - Phone:360-782-5700
Practice Address - Fax:253-984-2049
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991237-NP363LG0600X
WAAP60598224363LG0600X
VA0017138407363LG0600X
VA0024166673363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2138006Medicaid
Q79350Medicare UPIN
Q79350Medicare UPIN