Provider Demographics
NPI:1174135867
Name:BLACK, SHERI L (RN,BSN)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:L
Last Name:BLACK
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 E ERIE ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-5249
Mailing Address - Country:US
Mailing Address - Phone:919-673-8697
Mailing Address - Fax:
Practice Address - Street 1:3146 E WIER AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-2754
Practice Address - Country:US
Practice Address - Phone:602-845-0224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ239835163W00000X, 163WA0400X, 163WA2000X, 163WC0400X, 163WC1500X, 163WM0705X, 163WN1003X, 163WP0000X, 163WP0808X, 174H00000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No174H00000XOther Service ProvidersHealth Educator