1174511943 NPI number — SHARON L FELLION RNC WHNP

Table of content: SHARON L FELLION RNC WHNP (NPI 1174511943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174511943 NPI number — SHARON L FELLION RNC WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELLION
Provider First Name:
SHARON
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RNC WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FELLION
Provider Other First Name:
SHARON
Provider Other Middle Name:
LORRAINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
WHNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1174511943
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3123 SHORE DR STE 201
Provider Second Line Business Mailing Address:
WOMANS SPECIALTY CARE
Provider Business Mailing Address City Name:
MARINETTE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54143-4290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-735-6263
Provider Business Mailing Address Fax Number:
715-735-5692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3123 SHORE DR STE 201
Provider Second Line Business Practice Location Address:
WOMANS SPECIALTY CARE
Provider Business Practice Location Address City Name:
MARINETTE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54143-4290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-735-6263
Provider Business Practice Location Address Fax Number:
715-735-5692
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  4707086166 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 83033 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 83033 . This is a "LICENSE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 500018073-WI . This is a "RR - MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43939800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: ON42190 . This is a "MEDICAID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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