Provider Demographics
NPI:1144544867
Name:ISHIHARA, SHARON PENNY LYNNE (PMH NP-BC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:PENNY LYNNE
Last Name:ISHIHARA
Suffix:
Gender:F
Credentials:PMH NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-0212
Mailing Address - Country:US
Mailing Address - Phone:360-475-3712
Mailing Address - Fax:360-373-2096
Practice Address - Street 1:2508 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3303
Practice Address - Country:US
Practice Address - Phone:360-377-3776
Practice Address - Fax:360-373-2093
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60697095363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ144803OtherMEDICARE PTAN
AZZ144804OtherMEDICARE PTAN