Provider Demographics
NPI:1407430549
Name:BROCKLEHURST, BRONWYN A (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:BRONWYN
Middle Name:A
Last Name:BROCKLEHURST
Suffix:
Gender:F
Credentials:MPAS, PA-C
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-5275
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:79 N MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2344
Practice Address - Country:US
Practice Address - Phone:540-213-2525
Practice Address - Fax:540-213-2555
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA062367363A00000X
PAOA005610363A00000X
VA0110008085363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant