Provider Demographics
NPI:1376861302
Name:SHIRLEY, SHARON ANN (LPN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 RIO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-5463
Mailing Address - Country:US
Mailing Address - Phone:775-423-3634
Mailing Address - Fax:
Practice Address - Street 1:1001 RIO VISTA DR
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-5463
Practice Address - Country:US
Practice Address - Phone:775-423-3634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLPN12128164W00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No174H00000XOther Service ProvidersHealth Educator