Provider Demographics
NPI:1811566482
Name:EDMONDSON, SHARON MARY (RN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MARY
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11907 W DORA CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-4237
Mailing Address - Country:US
Mailing Address - Phone:316-409-9664
Mailing Address - Fax:
Practice Address - Street 1:11907 W DORA CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-4237
Practice Address - Country:US
Practice Address - Phone:316-409-9664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-78822163W00000X
KS13-128184163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse