Provider Demographics
NPI:1326532201
Name:ELIZABETH A SHARP-MARSDEN FNP PLLC
Entity Type:Organization
Organization Name:ELIZABETH A SHARP-MARSDEN FNP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHARP-MARSDEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:208-313-7900
Mailing Address - Street 1:PO BOX 2426
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-2426
Mailing Address - Country:US
Mailing Address - Phone:208-535-9009
Mailing Address - Fax:208-535-9020
Practice Address - Street 1:2275 CHANNING WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8012
Practice Address - Country:US
Practice Address - Phone:208-313-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID53940363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1326532201Medicaid