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General NPI Number Information
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NPI Number | 1598873044
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Entity Type | Individual
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Provider Name | SHARON E. POLACCA PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2035 MESQUITE SUITE E
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403
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Country | US
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Telephone | 928-717-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 1321 8TH ST
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City | PARKER
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State | AZ
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Zip | 85344
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Country | US
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Telephone | 928-669-2623
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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