Provider Demographics
NPI:1740403377
Name:HEALY, SHARON RAE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:RAE
Last Name:HEALY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14402 E SPRAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2167
Mailing Address - Country:US
Mailing Address - Phone:509-922-2625
Mailing Address - Fax:509-922-4001
Practice Address - Street 1:14402 E SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-2167
Practice Address - Country:US
Practice Address - Phone:509-922-4001
Practice Address - Fax:509-922-2625
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60166311363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2009697Medicaid
WAG8901372Medicare PIN
MT373520OtherBCBS PROVIDER NUMBER
MT4301238Medicaid