Provider Demographics
NPI:1457546707
Name:FROESE, SHARON W (APRN/CNM)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:W
Last Name:FROESE
Suffix:
Gender:F
Credentials:APRN/CNM
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:A
Other - Last Name:FROESE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP, CNM
Mailing Address - Street 1:PO BOX 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-579-3272
Mailing Address - Fax:
Practice Address - Street 1:2225 CIVIC CENTER DR
Practice Address - Street 2:STE. 230
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6338
Practice Address - Country:US
Practice Address - Phone:702-854-2953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9223502367A00000X
NVAPRN000571367A00000X
NVRN34302163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBT257ZOtherMEDICARE PTAN
FL002938500Medicaid
NVV112227Medicare PIN
NVV106516Medicare PIN