Provider Demographics
NPI:1083754162
Name:BOCCACCIO, SHERI LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:LYNN
Last Name:BOCCACCIO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:SHERI
Other - Middle Name:LYNN
Other - Last Name:BOCCACCIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1225 E BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1905
Mailing Address - Country:US
Mailing Address - Phone:248-524-8801
Mailing Address - Fax:248-524-8850
Practice Address - Street 1:1225 E BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1905
Practice Address - Country:US
Practice Address - Phone:248-524-8801
Practice Address - Fax:248-524-8850
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704109630163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse