Provider Demographics
NPI:1043279771
Name:SHERWIN, LEEANNE B (MS, APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:LEEANNE
Middle Name:B
Last Name:SHERWIN
Suffix:
Gender:F
Credentials:MS, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 CORTEZ AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7590
Mailing Address - Country:US
Mailing Address - Phone:208-522-4000
Mailing Address - Fax:208-528-4242
Practice Address - Street 1:2770 CORTEZ AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7590
Practice Address - Country:US
Practice Address - Phone:208-522-4000
Practice Address - Fax:208-528-4242
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN31764363L00000X
IDNP587363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1344128Medicare ID - Type Unspecified
IDS79315Medicare UPIN