Provider Demographics
NPI:1679762686
Name:SCANLON, SHARON (CNM, MS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:SCANLON
Suffix:
Gender:F
Credentials:CNM, MS
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:LYTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, MS
Mailing Address - Street 1:1520 S DOBSON RD STE 316
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4710
Mailing Address - Country:US
Mailing Address - Phone:480-545-0059
Mailing Address - Fax:480-632-2134
Practice Address - Street 1:1520 S DOBSON RD STE 316
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4710
Practice Address - Country:US
Practice Address - Phone:480-545-0059
Practice Address - Fax:480-632-2134
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ264231367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ123019Medicaid