Provider Demographics
NPI:1831133081
Name:FRIEDRICH, SHARON L (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:FRIEDRICH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:757 45TH ST STE 201
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2912
Practice Address - Country:US
Practice Address - Phone:219-922-5528
Practice Address - Fax:219-922-5526
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001561363L00000X
IN71001561A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200475510Medicaid
IN200475510AMedicaid
IN499500IIIMedicare PIN
IN200475510Medicaid