Provider Demographics
NPI:1386700318
Name:SHARON RUBICK
Entity type:Organization
Organization Name:SHARON RUBICK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RUBICK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:616-813-2679
Mailing Address - Street 1:2411 LAKE AVE
Mailing Address - Street 2:#21
Mailing Address - City:NORTH MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445
Mailing Address - Country:US
Mailing Address - Phone:616-813-2679
Mailing Address - Fax:231-719-2809
Practice Address - Street 1:2411 LAKE AVE
Practice Address - Street 2:#21
Practice Address - City:NORTH MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445
Practice Address - Country:US
Practice Address - Phone:616-813-2679
Practice Address - Fax:231-719-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704088816RN163WP0000X
MI4704088816 1879905171M00000X
MI4704088816 1878905332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF10335OtherBLUE CROSS BLUE SHIELD
MI0387030001Medicare ID - Type Unspecified