1942572615 NPI number — MS. SHARON LYNN RAFALKO RN

Table of content: MS. SHARON LYNN RAFALKO RN (NPI 1942572615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942572615 NPI number — MS. SHARON LYNN RAFALKO RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAFALKO
Provider First Name:
SHARON
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942572615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30800 TELEGRAPH RD STE. 2800
Provider Second Line Business Mailing Address:
UNITED PHYSICIANS
Provider Business Mailing Address City Name:
BINGHAMS FARMS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-593-0263
Provider Business Mailing Address Fax Number:
248-593-0175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30800 TELEGRAPH ROAD
Provider Second Line Business Practice Location Address:
SUITE 2800 UNITED PHYSICIANS
Provider Business Practice Location Address City Name:
BINGHAM FARMS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-593-0263
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2012

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: 163W00000X , with the licence number:  4704119032 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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