Provider Demographics
NPI:1639191471
Name:BRODIE, SHARON ELIZABETH (CRNP - PEDIATRICS)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ELIZABETH
Last Name:BRODIE
Suffix:
Gender:F
Credentials:CRNP - PEDIATRICS
Other - Prefix:MISS
Other - First Name:SHARON
Other - Middle Name:ELIZABETH
Other - Last Name:BISCHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP - PEDIATRICS
Mailing Address - Street 1:8109 RITCHIE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122
Mailing Address - Country:US
Mailing Address - Phone:410-590-8826
Mailing Address - Fax:410-768-1949
Practice Address - Street 1:8109 RITCHIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122
Practice Address - Country:US
Practice Address - Phone:410-590-8826
Practice Address - Fax:410-768-1949
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR089082363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
83014OtherPNCB
MDR089082OtherMBON