Provider Demographics
NPI:1407568157
Name:SHARP, NATHANA RAE (LPN)
Entity Type:Individual
Prefix:
First Name:NATHANA
Middle Name:RAE
Last Name:SHARP
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 1:26 DANDELION CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT STORM
Mailing Address - State:WV
Mailing Address - Zip Code:26739-8526
Mailing Address - Country:US
Mailing Address - Phone:304-813-3469
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL DR STE 3
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-9570
Practice Address - Country:US
Practice Address - Phone:304-257-1015
Practice Address - Fax:304-257-1129
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27572164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse