Provider Demographics
NPI:1205901220
Name:CARDENAS, SHARON ROSALIE
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ROSALIE
Last Name:CARDENAS
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 3386
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-3386
Mailing Address - Country:US
Mailing Address - Phone:530-893-2045
Mailing Address - Fax:
Practice Address - Street 1:4 SPRINGBROOK CT
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3194
Practice Address - Country:US
Practice Address - Phone:530-332-9642
Practice Address - Fax:530-332-9642
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434176163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
RVN001660Medicare PIN
CAEPS013190Medicare ID - Type Unspecified