Provider Demographics
NPI:1316396807
Name:LEVY, SHARON B (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:B
Last Name:LEVY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 LA BONITA DR
Mailing Address - Street 2:#316
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-5291
Mailing Address - Country:US
Mailing Address - Phone:760-744-9626
Mailing Address - Fax:
Practice Address - Street 1:1030 LA BONITA DR
Practice Address - Street 2:#316
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-5291
Practice Address - Country:US
Practice Address - Phone:760-744-9626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily