Provider Demographics
NPI:1558863860
Name:SHARPSHAIR, MARY T (FNP-BC, NP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:SHARPSHAIR
Suffix:
Gender:F
Credentials:FNP-BC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10651 BRIDLEPATH LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2911
Mailing Address - Country:US
Mailing Address - Phone:513-882-6735
Mailing Address - Fax:
Practice Address - Street 1:1000 COLUMBUS AVE STE B
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8330
Practice Address - Country:US
Practice Address - Phone:513-934-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022458363LF0000X
OHLE-00022763363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care