Provider Demographics
NPI:1124414032
Name:ANDERSON, SHERRI LYNN (LPN L61319-6)
Entity Type:Individual
Prefix:MS
First Name:SHERRI
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPN L61319-6
Other - Prefix:MRS
Other - First Name:SHERRI
Other - Middle Name:LYNN
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:29916 ANDERSON DR.
Mailing Address - Street 2:
Mailing Address - City:SANDSTONE
Mailing Address - State:MN
Mailing Address - Zip Code:55072
Mailing Address - Country:US
Mailing Address - Phone:320-515-0238
Mailing Address - Fax:
Practice Address - Street 1:29916 ANDERSON DR.
Practice Address - Street 2:
Practice Address - City:SANDSTONE
Practice Address - State:MN
Practice Address - Zip Code:55072
Practice Address - Country:US
Practice Address - Phone:320-515-0238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL61319-6164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse