Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 201710219NP-PP | OR |
N | 363LG0600X | Nurse Practitioner - Gerontology | 201710219NP-PP | OR |
NPI | 1013971340 |
---|---|
Provider Name | Mrs. Sharon Ann Vanarsdale |
First Address | Shady Cove, OR 97539-9717 |
Second Address | Shady Cove, OR 97539-9717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 01/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
424967313 | (05) | MO |
P94216 | (02) | MO |