Provider Demographics
NPI:1245231042
Name:MCCLURG, SHAROLYN LIANE (RN, CNP)
Entity type:Individual
Prefix:MS
First Name:SHAROLYN
Middle Name:LIANE
Last Name:MCCLURG
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:MS
Other - First Name:SHAROLYN
Other - Middle Name:LIANE
Other - Last Name:DING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1393 W ORIOLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-3161
Mailing Address - Country:US
Mailing Address - Phone:480-659-7596
Mailing Address - Fax:
Practice Address - Street 1:2025 N 3RD ST
Practice Address - Street 2:SUITE 170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1471
Practice Address - Country:US
Practice Address - Phone:602-462-1132
Practice Address - Fax:602-462-1186
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2145363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ953093Medicaid
AZ104283Medicare ID - Type Unspecified
AZ953093Medicaid