Provider Demographics
NPI:1669423653
Name:WHITMAN, SHARON LEE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LEE
Last Name:WHITMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SKYWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHUCKEY
Mailing Address - State:TN
Mailing Address - Zip Code:37641-5615
Mailing Address - Country:US
Mailing Address - Phone:423-844-2686
Mailing Address - Fax:423-844-2688
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-2686
Practice Address - Fax:423-844-2688
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA44906367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1508136Medicaid
TX145788901Medicaid
TX84075HMedicare ID - Type Unspecified
TX145788901Medicaid