Provider Demographics
NPI:1619410354
Name:SHARP, DAWN (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:SHARP
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 MIRROR DR
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:MI
Mailing Address - Zip Code:49249-9412
Mailing Address - Country:US
Mailing Address - Phone:517-937-0949
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-7339
Practice Address - Fax:269-341-7847
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704245866363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology