Provider Demographics
NPI:1962846436
Name:FREDERICK, SHARON KAY (RN)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:KAY
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 BROUSE BLVD W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-1513
Mailing Address - Country:US
Mailing Address - Phone:253-564-0289
Mailing Address - Fax:253-564-0289
Practice Address - Street 1:3913 BROUSE BLVD W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-1513
Practice Address - Country:US
Practice Address - Phone:253-564-0289
Practice Address - Fax:253-564-0289
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00167084163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse