Provider Demographics
NPI:1497894273
Name:SWEDENBORG, SHARON K (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:K
Last Name:SWEDENBORG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2048
Mailing Address - Country:US
Mailing Address - Phone:231-796-8691
Mailing Address - Fax:231-592-4494
Practice Address - Street 1:605 OAK ST
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2048
Practice Address - Country:US
Practice Address - Phone:231-796-8691
Practice Address - Fax:231-592-4494
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704204581367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4929810Medicaid
MI4704204581OtherSTATE LICENSE NUMBER