Provider Demographics
NPI:1649889262
Name:SHARP MCMILLEN, REBECCA LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:SHARP MCMILLEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DUNHAM AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-2528
Mailing Address - Country:US
Mailing Address - Phone:716-483-2344
Mailing Address - Fax:
Practice Address - Street 1:350 E 2ND ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5623
Practice Address - Country:US
Practice Address - Phone:716-483-4373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY790384-01163W00000X
PARN564977163W00000X
PASP022338363LF0000X
NYF346546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY790384OtherREGISTERED PROFESSIONAL NURSE
NYF346546OtherNY NURSE PRACTITIONER IN FAMILY HEALTH
PARN564977OtherREGISTERED NURSE
PASP022338OtherCERTIFIED REGISTERED NURSE PRACTITIONER