Provider Demographics
NPI:1891819678
Name:BREAKER, SHARRON KAY (PHN)
Entity Type:Individual
Prefix:MS
First Name:SHARRON
Middle Name:KAY
Last Name:BREAKER
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:MS
Other - First Name:SHERRY
Other - Middle Name:K
Other - Last Name:BREAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PUBLIC HEALTH NURSE
Mailing Address - Street 1:P O BOX 779
Mailing Address - Street 2:
Mailing Address - City:NOME,
Mailing Address - State:AK
Mailing Address - Zip Code:99762
Mailing Address - Country:US
Mailing Address - Phone:907-443-3221
Mailing Address - Fax:
Practice Address - Street 1:404 W 3RD ST.
Practice Address - Street 2:
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762
Practice Address - Country:US
Practice Address - Phone:907-443-3221
Practice Address - Fax:907-443-4869
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK24554163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health