Provider Demographics
NPI:1144552480
Name:MCDOUGAL, SHARON CAMIRAY (CPM, RM)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:CAMIRAY
Last Name:MCDOUGAL
Suffix:
Gender:F
Credentials:CPM, RM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7573
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-0573
Mailing Address - Country:US
Mailing Address - Phone:719-251-5197
Mailing Address - Fax:
Practice Address - Street 1:776 E PASEO DORADO DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-1154
Practice Address - Country:US
Practice Address - Phone:719-251-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO115176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife