| Doctor Name: | SHARON MACK DERSTINE |
| NPI Number: | 1104810480 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | AP30005738 |
| Business Practice Address: | 1106 E 1st St Port Angeles, WA - 983624317 |
| Business Phone Number: | 3604522954 |
| Business Fax Number: | 3604577683 |
| Mailing Address: | 1106 E 1st St, PORT ANGELES |
| State: | WA |
| Postal Code: | 983624317 |
| Phone Number: | 3604522954 |
| Fax Number: | 3604577683 |
| NPI Enumeration Date: | 09/01/2005 |
| NPI Last Update Date: | 07/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | AP30005738 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |