Provider Demographics
NPI:1619374725
Name:POSSEHL, SHARON EILEEN (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:EILEEN
Last Name:POSSEHL
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:25 MICHIGAN ST NE
Mailing Address - Street 2:SUITE 3300
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2515
Mailing Address - Country:US
Mailing Address - Phone:616-459-4171
Mailing Address - Fax:616-459-4171
Practice Address - Street 1:2093 HEALTH DR SW
Practice Address - Street 2:SUITE 202
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9691
Practice Address - Country:US
Practice Address - Phone:616-459-4171
Practice Address - Fax:616-459-0044
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2014-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704145687363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382285194OtherTAX ID