Provider Demographics
NPI:1871894410
Name:BLONDEAU, SHARON ELAINE (RN)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ELAINE
Last Name:BLONDEAU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8639C ENGLESIDE OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-4132
Mailing Address - Country:US
Mailing Address - Phone:703-725-8921
Mailing Address - Fax:
Practice Address - Street 1:8639C ENGLESIDE OFFICE PARK
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-4132
Practice Address - Country:US
Practice Address - Phone:703-725-8921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001212013163WG0000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center