Provider Demographics
NPI:1598061467
Name:NOLTE, SHARA RICHELLE (RN)
Entity Type:Individual
Prefix:MS
First Name:SHARA
Middle Name:RICHELLE
Last Name:NOLTE
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 1:8412 116TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2764
Mailing Address - Country:US
Mailing Address - Phone:763-229-6540
Mailing Address - Fax:
Practice Address - Street 1:8412 116TH AVE N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2764
Practice Address - Country:US
Practice Address - Phone:763-229-6540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR184933-8163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse