Provider Demographics
NPI:1801101316
Name:LEE-ROEDER, SHARON SUE (NP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:SUE
Last Name:LEE-ROEDER
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:SUE
Other - Last Name:NOFFSINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:300 N LEE BLVD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-5710
Practice Address - Country:US
Practice Address - Phone:928-708-4300
Practice Address - Fax:928-458-2122
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10956363LF0000X, 363LF0000X
CA23216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ362463Medicaid