Provider Demographics
NPI:1467807131
Name:WIEBERDINK, SHARAN (FNP)
Entity Type:Individual
Prefix:
First Name:SHARAN
Middle Name:
Last Name:WIEBERDINK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10097
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85130-0020
Mailing Address - Country:US
Mailing Address - Phone:520-836-3446
Mailing Address - Fax:
Practice Address - Street 1:23 S MCNAB PKWY
Practice Address - Street 2:
Practice Address - City:SAN MANUEL
Practice Address - State:AZ
Practice Address - Zip Code:85631
Practice Address - Country:US
Practice Address - Phone:520-385-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily