Provider Demographics
NPI:1154857290
Name:SHERER, REBECCA
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:SHERER
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 1:18289 W MINNEZONA AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7635
Mailing Address - Country:US
Mailing Address - Phone:623-680-8184
Mailing Address - Fax:
Practice Address - Street 1:20880 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-7641
Practice Address - Country:US
Practice Address - Phone:623-547-1318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN126721163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse