Provider Demographics
NPI:1861086829
Name:FAUBUSH, SHARON LANELLE
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:LANELLE
Last Name:FAUBUSH
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:PO BOX 1584
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85502-1584
Mailing Address - Country:US
Mailing Address - Phone:928-961-4828
Mailing Address - Fax:928-793-4029
Practice Address - Street 1:7760 S SIX SHOOTER CANYON RD
Practice Address - Street 2:
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-4078
Practice Address - Country:US
Practice Address - Phone:928-793-4603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL8314H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ546436OtherARIZONA LONG TERM CARE
AZ482790OtherARIZONA LONG TERM CARE