Provider Demographics
NPI:1629113717
Name:KOVNER, SHARI LIGGETT (RNFNP)
Entity Type:Individual
Prefix:MS
First Name:SHARI
Middle Name:LIGGETT
Last Name:KOVNER
Suffix:
Gender:F
Credentials:RNFNP
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:FAYE
Other - Last Name:LIGGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNFNP
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:OCCIDENTAL
Mailing Address - State:CA
Mailing Address - Zip Code:95465-0065
Mailing Address - Country:US
Mailing Address - Phone:707-874-3162
Mailing Address - Fax:
Practice Address - Street 1:3802 MAIN ST.
Practice Address - Street 2:
Practice Address - City:OCCIDENTAL
Practice Address - State:CA
Practice Address - Zip Code:95465
Practice Address - Country:US
Practice Address - Phone:707-874-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258327363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily