Provider Demographics
NPI:1922096098
Name:DEMUTH, SHARON LYNNE (RN BED)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LYNNE
Last Name:DEMUTH
Suffix:
Gender:F
Credentials:RN BED
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:LYNNE
Other - Last Name:DOTTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 231657
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-1657
Mailing Address - Country:US
Mailing Address - Phone:334-277-5431
Mailing Address - Fax:334-277-5433
Practice Address - Street 1:2921 ZELDA RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2682
Practice Address - Country:US
Practice Address - Phone:334-277-5431
Practice Address - Fax:334-277-5433
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1075635163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse