Provider Demographics
NPI:1154671527
Name:WASHBURN, SHERRY (MSN, RN, NP-C)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:MSN, RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2249 WEALTHY ST SE
Mailing Address - Street 2:STE 202
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3052
Mailing Address - Country:US
Mailing Address - Phone:248-952-1601
Mailing Address - Fax:248-952-1614
Practice Address - Street 1:3230 EAGLE PARK DR NE
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7007
Practice Address - Country:US
Practice Address - Phone:616-942-7733
Practice Address - Fax:616-942-7870
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI47041443371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily