Provider Demographics
NPI:1952394827
Name:ANDERSON, SHARON WESSEL (WHNP)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:WESSEL
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:HERMANTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55811-3626
Mailing Address - Country:US
Mailing Address - Phone:218-729-5974
Mailing Address - Fax:
Practice Address - Street 1:615 NIAGARA CT
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-3065
Practice Address - Country:US
Practice Address - Phone:218-726-8231
Practice Address - Fax:218-726-6132
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR87325363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1007763OtherPREFERRED ONE
MND48808OtherGROUP HEALTH
MN0701063OtherMEDICA
MNP28932Medicare UPIN