Provider Demographics
NPI:1972960011
Name:MITCHELL, SHARON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:MITCHELL
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:PO BOX 45
Mailing Address - Street 2:161 1ST STREET
Mailing Address - City:MORTON
Mailing Address - State:WA
Mailing Address - Zip Code:98356
Mailing Address - Country:US
Mailing Address - Phone:360-324-9040
Mailing Address - Fax:
Practice Address - Street 1:1401 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1901
Practice Address - Country:US
Practice Address - Phone:360-324-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA$$$$$$$$$Medicaid