Provider Demographics
NPI:1679949507
Name:VEJVODA, SHARON RENE (NP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:RENE
Last Name:VEJVODA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 WHITE LN
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-6279
Mailing Address - Country:US
Mailing Address - Phone:661-396-7100
Mailing Address - Fax:661-396-7101
Practice Address - Street 1:5401 WHITE LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-6279
Practice Address - Country:US
Practice Address - Phone:661-396-7100
Practice Address - Fax:661-396-7101
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF95002316363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily