Provider Demographics
NPI:1205076692
Name:DITTRICH, SHARON BOEHMER (RN NP)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:BOEHMER
Last Name:DITTRICH
Suffix:
Gender:F
Credentials:RN NP
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Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-0301
Mailing Address - Country:US
Mailing Address - Phone:310-456-6504
Mailing Address - Fax:310-456-1743
Practice Address - Street 1:3327 SUMAC RIDGE RD
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5131
Practice Address - Country:US
Practice Address - Phone:310-720-3327
Practice Address - Fax:310-456-1743
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA193479163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse