Provider Demographics
NPI:1740222140
Name:MATLOCK, SHARON (APN CNM)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:MATLOCK
Suffix:
Gender:F
Credentials:APN CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-1019
Mailing Address - Country:US
Mailing Address - Phone:312-945-4048
Mailing Address - Fax:312-945-4088
Practice Address - Street 1:3525 S MICHIGAN AVE
Practice Address - Street 2:NEAR SOUTH HEALTH CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-1019
Practice Address - Country:US
Practice Address - Phone:312-945-4048
Practice Address - Fax:312-945-4088
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001095367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife