Provider Demographics
NPI:1568455087
Name:CORRIVEAU, SHARON KAY (NP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:KAY
Last Name:CORRIVEAU
Suffix:
Gender:F
Credentials:NP
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 1244
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:WA
Mailing Address - Zip Code:98236-1244
Mailing Address - Country:US
Mailing Address - Phone:703-380-2189
Mailing Address - Fax:
Practice Address - Street 1:8150 LOPEZ DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:WA
Practice Address - Zip Code:98236-9236
Practice Address - Country:US
Practice Address - Phone:703-380-2189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61098656363L00000X
WA61035484163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7780656Medicaid
VA7780656Medicaid