Provider Demographics
NPI:1790932085
Name:SOUTHWICK, SHARON L (FNP)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:L
Last Name:SOUTHWICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W MARINA DR APT 29
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-3923
Mailing Address - Country:US
Mailing Address - Phone:509-431-5847
Mailing Address - Fax:
Practice Address - Street 1:801 WHEELER RD
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837
Practice Address - Country:US
Practice Address - Phone:509-765-5606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60027393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily