Provider Demographics
NPI:1669779864
Name:BOOMER, SHARON ELAINE
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ELAINE
Last Name:BOOMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:ELAINE
Other - Last Name:HERBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 E MAIN ST
Mailing Address - Street 2:BUILDING 53 ADMISSION
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-5305
Mailing Address - Country:US
Mailing Address - Phone:405-573-6623
Mailing Address - Fax:405-573-6644
Practice Address - Street 1:900 E MAIN ST
Practice Address - Street 2:BUILDING 53 ADMISSION
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-5305
Practice Address - Country:US
Practice Address - Phone:405-573-6623
Practice Address - Fax:405-573-6644
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker