Provider Demographics
NPI:1093831752
Name:THOMAS, SHERRIE LEE (FNP)
Entity Type:Individual
Prefix:
First Name:SHERRIE
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHERRIE
Other - Middle Name:LEE
Other - Last Name:STACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2220 SE 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2268
Mailing Address - Country:US
Mailing Address - Phone:360-834-7312
Mailing Address - Fax:
Practice Address - Street 1:CASCADE PARK MEDICAL OFFICE. 12607 SE MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6055
Practice Address - Country:US
Practice Address - Phone:360-891-6236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005584363LF0000X
OR078041931N1 FNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily