Provider Demographics
NPI:1801921960
Name:ANDREATTA, SHARON L (CFNP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:ANDREATTA
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CENTRAL PARK SQ
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-4021
Mailing Address - Country:US
Mailing Address - Phone:505-662-4798
Mailing Address - Fax:
Practice Address - Street 1:118 CENTRAL PARK SQ
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-4021
Practice Address - Country:US
Practice Address - Phone:505-662-4798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR30557163WD0400X, 163WN1003X
NMCNP-01668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support