Provider Demographics
NPI:1861638157
Name:HASTING, SHARON RUTH (APN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:RUTH
Last Name:HASTING
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:RUTH
Other - Last Name:HASTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13216 E KRISE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:IL
Mailing Address - Zip Code:61085-9403
Mailing Address - Country:US
Mailing Address - Phone:815-990-3276
Mailing Address - Fax:
Practice Address - Street 1:1639 N ALPINE RD
Practice Address - Street 2:STE 403
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1440
Practice Address - Country:US
Practice Address - Phone:815-990-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL309-000993363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner