Provider Demographics
NPI:1144395534
Name:FANARA, SHERRY L
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:L
Last Name:FANARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 JOEL DR
Mailing Address - Street 2:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Mailing Address - City:FT. CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5349
Mailing Address - Country:US
Mailing Address - Phone:270-798-8727
Mailing Address - Fax:270-956-0180
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Practice Address - City:FT. CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5349
Practice Address - Country:US
Practice Address - Phone:270-798-8727
Practice Address - Fax:270-956-0180
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN