Provider Demographics
NPI:1003906587
Name:KNEEBONE, SHERRIE DENISE (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHERRIE
Middle Name:DENISE
Last Name:KNEEBONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MOWRY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1605
Mailing Address - Country:US
Mailing Address - Phone:510-795-2004
Mailing Address - Fax:510-742-9285
Practice Address - Street 1:2000 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1716
Practice Address - Country:US
Practice Address - Phone:510-795-2004
Practice Address - Fax:510-742-9285
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA592295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70999FMedicaid
CACMM70999FMedicaid
CAZZZ26048ZMedicare PIN