Provider Demographics
NPI:1790544468
Name:THOMSON, SHARLENE BAILEY (RN)
Entity Type:Individual
Prefix:
First Name:SHARLENE
Middle Name:BAILEY
Last Name:THOMSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHARLENE
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3379 S 800 W
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-8002
Mailing Address - Country:US
Mailing Address - Phone:801-529-2559
Mailing Address - Fax:
Practice Address - Street 1:3875 STADIUM WAY DEPT 3903
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408-3903
Practice Address - Country:US
Practice Address - Phone:801-626-7833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT289186-3102163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice