Provider Demographics
NPI:1538584206
Name:PICKETT, SHARON MARIE
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:MARIE
Last Name:PICKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18300 WODA AVE.
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-6441
Mailing Address - Country:US
Mailing Address - Phone:216-482-2959
Mailing Address - Fax:216-921-1212
Practice Address - Street 1:18300 WODA AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44122-6441
Practice Address - Country:US
Practice Address - Phone:217-482-2959
Practice Address - Fax:216-921-1212
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN212283163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse