Provider Demographics
NPI:1710536289
Name:STEPHAN, SHARON DIANE
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:DIANE
Last Name:STEPHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 PLUM ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-4134
Mailing Address - Country:US
Mailing Address - Phone:304-422-2397
Mailing Address - Fax:
Practice Address - Street 1:1402 PLUM ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4134
Practice Address - Country:US
Practice Address - Phone:304-422-2397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant