Basic Information
| Provider Information | |||||||||
| NPI: | 1619362415 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIN | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2695 ROCKY MOUNTAIN AVE STE 150 | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805389071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706244123 | ||||||||
| FaxNumber: | 9706242416 | ||||||||
| Practice Location | |||||||||
| Address1: | 595 CHAPEL HILLS DR STE 240 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809201056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193644120 | ||||||||
| FaxNumber: | 7193644121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2015 | ||||||||
| LastUpdateDate: | 11/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Y00000X | 72624-20 | WI | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | DR.0069546 | CO | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 1619362415 | 05 | WI | MEDICAID |