Provider Demographics
NPI:1568582518
Name:BREMMER, SHARON JOYCE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:JOYCE
Last Name:BREMMER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30899 BYRDS CREEK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BLUE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:53518-4942
Mailing Address - Country:US
Mailing Address - Phone:608-537-2255
Mailing Address - Fax:
Practice Address - Street 1:30899 BYRDS CREEK VALLEY DR
Practice Address - Street 2:
Practice Address - City:BLUE RIVER
Practice Address - State:WI
Practice Address - Zip Code:53518-4942
Practice Address - Country:US
Practice Address - Phone:608-537-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33308-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39927100Medicaid