Provider Demographics
NPI:1851868558
Name:CHISM, SHARON L
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:CHISM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 TANGERINE CT APT 711
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-1300
Mailing Address - Country:US
Mailing Address - Phone:214-779-8772
Mailing Address - Fax:682-234-4530
Practice Address - Street 1:1409 TANGERINE CT APT 711
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-1300
Practice Address - Country:US
Practice Address - Phone:214-779-8772
Practice Address - Fax:682-234-4530
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information