Provider Demographics
NPI:1073891149
Name:SHERRY, CHARNAI DAWN (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:CHARNAI
Middle Name:DAWN
Last Name:SHERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CHARNAI
Other - Middle Name:DAWN
Other - Last Name:FANKHANEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2901 W KINNICKINNIC RIVER PKWY STE 507
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3677
Mailing Address - Country:US
Mailing Address - Phone:414-649-3780
Mailing Address - Fax:414-649-3794
Practice Address - Street 1:2901 W KINNICKINNIC RIVER PKWY STE 507
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215
Practice Address - Country:US
Practice Address - Phone:414-649-3780
Practice Address - Fax:414-649-3794
Is Sole Proprietor?:No
Enumeration Date:2011-07-23
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2808-023363AS0400X
WI2808363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1073891149Medicaid