Provider Demographics
NPI:1427702703
Name:RAMBO, SHARON (MASTERS T PLUS 30)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:RAMBO
Suffix:
Gender:F
Credentials:MASTERS T PLUS 30
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-6054
Mailing Address - Country:US
Mailing Address - Phone:318-281-2649
Mailing Address - Fax:318-582-5646
Practice Address - Street 1:1204 STUBBS AVE STE B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-582-5633
Practice Address - Fax:318-582-5646
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator