Provider Demographics
NPI:1174797294
Name:FORLENZA-STEVENS, SHARON SUSAN (RN,CRNP)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:SUSAN
Last Name:FORLENZA-STEVENS
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Gender:F
Credentials:RN,CRNP
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Mailing Address - Street 1:15 PUBLIC SQ
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-1702
Mailing Address - Country:US
Mailing Address - Phone:570-826-1777
Mailing Address - Fax:570-823-3040
Practice Address - Street 1:10 W CHESTNUT ST
Practice Address - Street 2:STE 6
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6423
Practice Address - Country:US
Practice Address - Phone:570-501-2941
Practice Address - Fax:570-501-1194
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2015-10-28
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Provider Licenses
StateLicense IDTaxonomies
PASP001047G363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007678420035Medicaid
PA1007678420033Medicaid
PA1025994230001Medicaid
PA1025994230002Medicaid