Provider Demographics
NPI:1558716621
Name:BUSEMAN EGAN, SHARON (CPDA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BUSEMAN EGAN
Suffix:
Gender:F
Credentials:CPDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-5837
Mailing Address - Country:US
Mailing Address - Phone:605-370-2268
Mailing Address - Fax:
Practice Address - Street 1:409 E 41ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-5837
Practice Address - Country:US
Practice Address - Phone:605-370-2268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD48T-3351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist