Provider Demographics
NPI:1154808186
Name:MAXSON, SHARON (LPN)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:MAXSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:PLUMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 GOFFS FALLS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-6109
Mailing Address - Country:US
Mailing Address - Phone:800-995-2673
Mailing Address - Fax:
Practice Address - Street 1:3000 GOFFS FALLS RD STE 101
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-6109
Practice Address - Country:US
Practice Address - Phone:800-995-2673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60221100164W00000X
MTLPN30606164W00000X
OR201030337LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse