Provider Demographics
NPI:1306581897
Name:OTWORTH, SHARON GRANTE (RN)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:GRANTE
Last Name:OTWORTH
Suffix:
Gender:F
Credentials:RN
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 1525
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-1525
Mailing Address - Country:US
Mailing Address - Phone:614-512-2711
Mailing Address - Fax:
Practice Address - Street 1:CAO SCIOTO COUNTY, 411 2ND STREET
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3806
Practice Address - Country:US
Practice Address - Phone:740-354-7545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH320754163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse