Healthcare Provider Details

I. General information

NPI: 1407024359
Provider Name (Legal Business Name): SHARON STATEN BRASHEAR CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 LAKE COVE CT
SUFFOLK VA
23435-2933
US

IV. Provider business mailing address

6701 LAKE COVE CT
SUFFOLK VA
23435-2933
US

V. Phone/Fax

Practice location:
  • Phone: 757-686-0636
  • Fax:
Mailing address:
  • Phone: 757-686-0636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number0024167096
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: