Provider Demographics
NPI:1053430652
Name:MOWREY, SHARON ANN (PA-C)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:MOWREY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:ANN
Other - Last Name:LEISY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3333 CLANDON PARK DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-8841
Mailing Address - Country:US
Mailing Address - Phone:919-630-0775
Mailing Address - Fax:
Practice Address - Street 1:3333 CLANDON PARK DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-8841
Practice Address - Country:US
Practice Address - Phone:919-630-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101304363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC101304OtherMEDICAL BOARD NUMBER
NCS53930Medicare UPIN
2745820Medicare ID - Type Unspecified