Basic Information
| Provider Information | |||||||||
| NPI: | 1649382193 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHARP | ||||||||
| FirstName: | EILEEN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 HIGHLAND RD | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD CENTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 062501504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604288729 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21 WATERVILLE RD | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060012097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606742691 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 363L00000X | 000617 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.