Provider Demographics
NPI:1336683796
Name:ZELL, SHARON KAYE (ARNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:KAYE
Last Name:ZELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 NE ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-6416
Mailing Address - Country:US
Mailing Address - Phone:425-244-4303
Mailing Address - Fax:
Practice Address - Street 1:1191 NE ROSS AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-6416
Practice Address - Country:US
Practice Address - Phone:425-244-4303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60711956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC367046OtherOR DOL
WAAP 60711956OtherWA STATE DOH