Provider Demographics
NPI:1881977163
Name:BORMANN, SHARON A
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:BORMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N. CENTER ST
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:IA
Mailing Address - Zip Code:50645-9496
Mailing Address - Country:US
Mailing Address - Phone:641-330-5332
Mailing Address - Fax:
Practice Address - Street 1:407 N. CENTER ST
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:IA
Practice Address - Zip Code:50645-9496
Practice Address - Country:US
Practice Address - Phone:641-330-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA641YY4219347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle