Provider Demographics
NPI:1962846220
Name:GRUSH, SHARON DENISE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:DENISE
Last Name:GRUSH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 FANTASY LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-4737
Mailing Address - Country:US
Mailing Address - Phone:409-363-3783
Mailing Address - Fax:
Practice Address - Street 1:507 FANTASY LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-4737
Practice Address - Country:US
Practice Address - Phone:409-363-3783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX703586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily