Provider Demographics
NPI:1881177145
Name:ELLIS, SHARON KRISTINE (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:KRISTINE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5871 SW BADGER RD
Mailing Address - Street 2:
Mailing Address - City:TERREBONNE
Mailing Address - State:OR
Mailing Address - Zip Code:97760-8936
Mailing Address - Country:US
Mailing Address - Phone:503-313-2618
Mailing Address - Fax:
Practice Address - Street 1:5871 SW BADGER RD
Practice Address - Street 2:
Practice Address - City:TERREBONNE
Practice Address - State:OR
Practice Address - Zip Code:97760-8936
Practice Address - Country:US
Practice Address - Phone:503-313-2618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR096007212RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR096007212RNOtherRN LICENSE