Provider Demographics
NPI:1467563577
Name:PICKLES, SHARON K
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:K
Last Name:PICKLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:IL
Mailing Address - Zip Code:60424-6176
Mailing Address - Country:US
Mailing Address - Phone:815-252-3524
Mailing Address - Fax:
Practice Address - Street 1:302 S CENTER ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:IL
Practice Address - Zip Code:60424-6176
Practice Address - Country:US
Practice Address - Phone:815-252-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3852770001Medicare NSC