Provider Demographics
NPI:1679667141
Name:MATTIOLI, SHARON R (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:R
Last Name:MATTIOLI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:R
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:781 MILL ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1320
Mailing Address - Country:US
Mailing Address - Phone:775-398-1981
Mailing Address - Fax:775-398-1981
Practice Address - Street 1:330 E LIBERTY ST STE 200
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-2221
Practice Address - Country:US
Practice Address - Phone:775-398-3630
Practice Address - Fax:775-398-3685
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN 000736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510742Medicaid
Q73737Medicare UPIN
NVV102880Medicare PIN
NVP00382117Medicare PIN