Provider Demographics
NPI:1891870614
Name:REDERFORD, SHARON A (ARNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:REDERFORD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3732 LAKESIDE DR
Mailing Address - Street 2:STE 202
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4519
Mailing Address - Country:US
Mailing Address - Phone:775-376-8274
Mailing Address - Fax:775-470-6636
Practice Address - Street 1:3732 LAKESIDE DR STE 202
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4519
Practice Address - Country:US
Practice Address - Phone:775-626-0974
Practice Address - Fax:775-470-6636
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002438363LP0808X
NVAP30001247363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1891870614Medicaid
WA9635186Medicaid
4098OtherINTERNAL ID-MOTOR VEHICLE ID
WA1891870614OtherPSYCHIATRIY