Provider Demographics
NPI:1093426934
Name:RICKAN, SHERRY LILLIAN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:LILLIAN
Last Name:RICKAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 RILEY SWITCH RD
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01331-9498
Mailing Address - Country:US
Mailing Address - Phone:508-574-5993
Mailing Address - Fax:
Practice Address - Street 1:242 GREEN ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-1336
Practice Address - Country:US
Practice Address - Phone:978-630-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAF05220260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine