Provider Demographics
NPI:1104437300
Name:SHARPE, RYAN LEE BALAG (NURSING ASSISTANT)
Entity type:Individual
Prefix:
First Name:RYAN LEE
Middle Name:BALAG
Last Name:SHARPE
Suffix:
Gender:M
Credentials:NURSING ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10317 110TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-1515
Mailing Address - Country:US
Mailing Address - Phone:253-533-4815
Mailing Address - Fax:
Practice Address - Street 1:10317 110TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-1515
Practice Address - Country:US
Practice Address - Phone:253-533-4815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC60553625376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWDL23B79673BOtherDRIVER'S LICENSE