Provider Demographics
NPI:1669502084
Name:KUSNE, SHARON (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:
Last Name:KUSNE
Suffix:
Gender:F
Credentials:CRNP
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 45053
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-5053
Mailing Address - Country:US
Mailing Address - Phone:480-289-6898
Mailing Address - Fax:480-289-6897
Practice Address - Street 1:500 W THOMAS RD
Practice Address - Street 2:SUITE #980
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4224
Practice Address - Country:US
Practice Address - Phone:480-289-6898
Practice Address - Fax:480-289-6897
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZWCSKQOtherSUN HEALTH GROUP #
AZ211097Medicaid
AZP00409983OtherRAILROAD MEDICARE
AZZ115461Medicare PIN
AZP00409983OtherRAILROAD MEDICARE