Provider Demographics
NPI:1497894752
Name:RUBICK, SHARON (RN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:RUBICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 LAKE AVE
Mailing Address - Street 2:#21
Mailing Address - City:NORTH MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-3300
Mailing Address - Country:US
Mailing Address - Phone:616-813-2679
Mailing Address - Fax:231-719-2809
Practice Address - Street 1:2411 LAKE AVE
Practice Address - Street 2:#21
Practice Address - City:NORTH MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-3300
Practice Address - Country:US
Practice Address - Phone:616-813-2679
Practice Address - Fax:231-719-2809
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704088816163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0000XNursing Service ProvidersRegistered NursePain Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0387030001Medicare ID - Type Unspecified