Provider Demographics
NPI:1790964997
Name:STOCKWELL, SHARON L (CNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:STOCKWELL
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 1:34851 KENAI SPUR HWY STE 7
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7646
Mailing Address - Country:US
Mailing Address - Phone:907-262-1900
Mailing Address - Fax:
Practice Address - Street 1:34851 KENAI SPUR HWY STE 7
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7646
Practice Address - Country:US
Practice Address - Phone:907-262-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-03878363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2179584Medicaid
NP29291Medicare PIN