Provider Demographics
NPI:1982799656
Name:GILMORE, SHARON (CRNP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:GILMORE
Suffix:
Gender:F
Credentials:CRNP
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 447
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0447
Mailing Address - Country:US
Mailing Address - Phone:814-653-8222
Mailing Address - Fax:814-653-8164
Practice Address - Street 1:5 N 3RD ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15851-0907
Practice Address - Country:US
Practice Address - Phone:814-653-8222
Practice Address - Fax:814-653-9305
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007736363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
P90941Medicare UPIN
PA070373FFUMedicare PIN