Provider Demographics
NPI:1669924585
Name:WHYTE, SHARON ANGELETTE (CNP)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANGELETTE
Last Name:WHYTE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:ANGELETTE
Other - Last Name:WHYTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:184 UNSER BLVD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4045
Mailing Address - Country:US
Mailing Address - Phone:505-896-0928
Mailing Address - Fax:505-896-0585
Practice Address - Street 1:184 UNSER BLVD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124
Practice Address - Country:US
Practice Address - Phone:505-896-0928
Practice Address - Fax:505-896-0585
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM003367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1669924585Medicaid