MEDICARE: SHARON L HART PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	AA169	AK

General Provider Information

NPI Number	:	1376708347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON L HART PA-C

Provider Business Mailing Address
First Line	:	PO BOX 520558
Second Line	:
City	:	BIG LAKE
State	:	AK
Zip	:	99652-0558
Country	:	US
Telephone Number	:	907-892-8945
Fax Number	:

Provider Business Practice Location Address
First Line	:	MILE 69.1 PARKS HIGHWAY
Second Line	:
City	:	WILLOW
State	:	AK
Zip	:	99688
Country	:	US
Telephone Number	:	907-495-4362
Fax Number	:	907-495-4363

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2008
Last Update Date	:	07/18/2008

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