Provider Demographics
NPI:1053000109
Name:BEAN-SARGENT, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BEAN-SARGENT
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 1:16192 RYLAND
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-2513
Mailing Address - Country:US
Mailing Address - Phone:313-828-3579
Mailing Address - Fax:
Practice Address - Street 1:16192 RYLAND
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-2513
Practice Address - Country:US
Practice Address - Phone:313-828-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider