Provider Demographics
NPI:1912257312
Name:BATES, SHARON L (BA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:L
Last Name:BATES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 WEST C ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240
Mailing Address - Country:US
Mailing Address - Phone:307-532-0134
Mailing Address - Fax:307-532-0134
Practice Address - Street 1:2802 WEST C ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240
Practice Address - Country:US
Practice Address - Phone:307-532-0134
Practice Address - Fax:307-532-0134
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator