Provider Demographics
NPI:1902041551
Name:GALA, SHARON L (NP)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:L
Last Name:GALA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:L
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1743 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-0927
Mailing Address - Country:US
Mailing Address - Phone:928-757-8111
Mailing Address - Fax:928-757-3256
Practice Address - Street 1:2187 SWANSON AVE
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6838
Practice Address - Country:US
Practice Address - Phone:928-855-3432
Practice Address - Fax:928-855-0103
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN068663363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q41686Medicare UPIN