Provider Demographics
NPI:1942455712
Name:PREVOST, SHARON LOIS
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LOIS
Last Name:PREVOST
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 1:2820 WRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-5009
Mailing Address - Country:US
Mailing Address - Phone:262-635-0808
Mailing Address - Fax:
Practice Address - Street 1:2820 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-5009
Practice Address - Country:US
Practice Address - Phone:262-635-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI138273030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health