Provider Demographics
NPI:1780669309
Name:AUSTIN, SHARON A (CNP)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:A
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S BLOOMINGTON ST
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-2904
Mailing Address - Country:US
Mailing Address - Phone:815-673-2441
Mailing Address - Fax:815-672-2178
Practice Address - Street 1:200 E 6TH ST
Practice Address - Street 2:
Practice Address - City:MINONK
Practice Address - State:IL
Practice Address - Zip Code:61760-1308
Practice Address - Country:US
Practice Address - Phone:309-432-2441
Practice Address - Fax:309-432-3711
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL309000390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
998430Medicare ID - Type Unspecified
S97637Medicare UPIN
998440Medicare ID - Type Unspecified