Basic Information
| Provider Information | |||||||||
| NPI: | 1760471510 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNLY | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | RN, MSN, ANP, CGNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13634 N 93RD AVE | ||||||||
| Address2: | #100 | ||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239330301 | ||||||||
| FaxNumber: | 6239330224 | ||||||||
| Practice Location | |||||||||
| Address1: | 18731 N REEMS RD | ||||||||
| Address2: | #680 | ||||||||
| City: | SURPRISE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239750592 | ||||||||
| FaxNumber: | 6239750750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2005 | ||||||||
| LastUpdateDate: | 01/14/2010 | ||||||||
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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 | 363LG0600X | RN098246 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 207R00000X | RN098246 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | RN098246 | 01 | AZ | STATE LICENSE | OTHER | MH0055271 | 01 | AZ | DEA | OTHER | 726664 | 05 | AZ | MEDICAID |