Basic Information
| Provider Information | |||||||||
| NPI: | 1083708531 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILBUR | ||||||||
| FirstName: | SHAREN | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1510 ORANGE AVENUE, UNIT 901 | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923731499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097924931 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | VA LOMA LINDA HEALTHCARE SYSTEM | ||||||||
| Address2: | 11201 BENTON STREET | ||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007418387 | ||||||||
| FaxNumber: | 9095836723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 02/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 14064 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.