Provider Demographics
NPI:1811450067
Name:MO, SHARLA
Entity type:Individual
Prefix:
First Name:SHARLA
Middle Name:
Last Name:MO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 N WINDSONG DR STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2219
Mailing Address - Country:US
Mailing Address - Phone:928-968-7400
Mailing Address - Fax:928-379-6737
Practice Address - Street 1:3155 N WINDSONG DR STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2219
Practice Address - Country:US
Practice Address - Phone:928-968-7400
Practice Address - Fax:928-379-6737
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-99875-091163W00000X
MO2006019378163W00000X
MO2019019648363LF0000X
AZ261898363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457026460OtherPRESCOTT VALLEY LOCATION NPI
AZ261898OtherSTATE LICENSE