Provider Demographics
NPI:1376897975
Name:SHARP, ADAM RICHARD (LPN)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:RICHARD
Last Name:SHARP
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 COUNTY ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:13167-4158
Mailing Address - Country:US
Mailing Address - Phone:315-668-7295
Mailing Address - Fax:
Practice Address - Street 1:1051 COUNTY ROUTE 11
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:NY
Practice Address - Zip Code:13167-4158
Practice Address - Country:US
Practice Address - Phone:315-668-7295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-04
Last Update Date:2012-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306184164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse