Provider Demographics
NPI:1417186388
Name:WALSH, SHARON JEAN (LVN)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:JEAN
Last Name:WALSH
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10282 MCCRACKEN DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-5419
Mailing Address - Country:US
Mailing Address - Phone:916-792-9873
Mailing Address - Fax:
Practice Address - Street 1:10282 MCCRACKEN DR
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-5419
Practice Address - Country:US
Practice Address - Phone:916-792-9873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN67917164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse