Provider Demographics
NPI:1669469078
Name:BRYAN, SHEILA M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:M
Last Name:BRYAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:SHEILA
Other - Middle Name:MARIE
Other - Last Name:STOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 BANK ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-2204
Mailing Address - Country:US
Mailing Address - Phone:515-832-6700
Mailing Address - Fax:515-832-3534
Practice Address - Street 1:510 BANK ST
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-2204
Practice Address - Country:US
Practice Address - Phone:515-832-6700
Practice Address - Fax:515-832-3534
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001108363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI21856Medicare PIN
IAS69070Medicare UPIN