Provider Demographics
NPI:1750312302
Name:BRAMBLEE, SHARRON K (CNP PAC)
Entity Type:Individual
Prefix:
First Name:SHARRON
Middle Name:K
Last Name:BRAMBLEE
Suffix:
Gender:F
Credentials:CNP PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7236 JORDAN DR
Mailing Address - Street 2:STE 100A
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8740
Mailing Address - Country:US
Mailing Address - Phone:605-718-3747
Mailing Address - Fax:605-718-3047
Practice Address - Street 1:7236 JORDAN DR
Practice Address - Street 2:SUITE 100 A
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8740
Practice Address - Country:US
Practice Address - Phone:605-718-3747
Practice Address - Fax:605-718-3047
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0192363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7511OtherUNSPECIFIED
SD6201104Medicaid
SD6201104Medicaid