Provider Demographics
NPI:1134207277
Name:BETTINGER, SHARON LYNN (PA)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:LYNN
Last Name:BETTINGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18237 N 71ST DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8104
Mailing Address - Country:US
Mailing Address - Phone:602-978-4750
Mailing Address - Fax:
Practice Address - Street 1:34597 N 60TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-5240
Practice Address - Country:US
Practice Address - Phone:480-473-7800
Practice Address - Fax:480-513-8704
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3085363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ103605Medicare ID - Type UnspecifiedMEDICARAE
AZP50444Medicare UPIN