Provider Demographics
NPI:1801102736
Name:KIEHNBAUM, SHARI L (PA-C)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:L
Last Name:KIEHNBAUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FOUNDERS PL
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611-1476
Mailing Address - Country:US
Mailing Address - Phone:970-920-0104
Mailing Address - Fax:
Practice Address - Street 1:101 FOUNDERS PL
Practice Address - Street 2:SUITE 109
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1476
Practice Address - Country:US
Practice Address - Phone:970-920-0104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA-3064363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical