Provider Demographics
NPI:1891038048
Name:RENT, SHARLA MARIE
Entity Type:Individual
Prefix:
First Name:SHARLA
Middle Name:MARIE
Last Name:RENT
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 1:17540 KODIAK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-9286
Mailing Address - Country:US
Mailing Address - Phone:707-637-6122
Mailing Address - Fax:
Practice Address - Street 1:1465 SOUTH GRAND BLVD, ROOM 1204
Practice Address - Street 2:SSM CARDINAL GLENNON CHILDREN'S MEDICAL CENTER
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104
Practice Address - Country:US
Practice Address - Phone:314-577-5600
Practice Address - Fax:314-577-5616
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program