Provider Demographics
NPI:1457501843
Name:MCELVENY, SHARON ANN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ANN
Last Name:MCELVENY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 LAZY TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-7736
Mailing Address - Country:US
Mailing Address - Phone:530-899-8622
Mailing Address - Fax:
Practice Address - Street 1:7540 NORTH 19TH AVENUE #200
Practice Address - Street 2:
Practice Address - City:PHOENIZ
Practice Address - State:AZ
Practice Address - Zip Code:85021
Practice Address - Country:US
Practice Address - Phone:888-873-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA225X00000XMedicare UPIN