Basic Information
| Provider Information | |||||||||
| NPI: | 1164646014 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENRY | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | MICHELE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 JANWALL ST | ||||||||
| Address2: | |||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214031937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102805214 | ||||||||
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| Practice Location | |||||||||
| Address1: | DILORENZO TRICARE HEALTH CLINIC | ||||||||
| Address2: | 5801 ARMY PENTAGON | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 203100001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036397605 | ||||||||
| FaxNumber: | 9103231913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 05/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | C0001973 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 139762 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA030316 | DC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.