Provider Demographics
NPI:1467569855
Name:PONCE, SHARON LEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LEE
Last Name:PONCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:19 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6701
Mailing Address - Country:US
Mailing Address - Phone:480-968-9890
Mailing Address - Fax:480-968-9890
Practice Address - Street 1:2078 E SOUTHERN AVE STE D101
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7545
Practice Address - Country:US
Practice Address - Phone:480-968-9890
Practice Address - Fax:480-968-9895
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN106409363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS25018Medicare UPIN