Provider Demographics
NPI:1164612834
Name:SHERK, KAREN GRACE
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:GRACE
Last Name:SHERK
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 1:6445 RICHFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-6400
Mailing Address - Country:US
Mailing Address - Phone:612-252-0473
Mailing Address - Fax:
Practice Address - Street 1:3625 W 65TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2106
Practice Address - Country:US
Practice Address - Phone:952-920-7001
Practice Address - Fax:952-920-2245
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR157284-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily