Provider Demographics
NPI:1194836460
Name:SHERBURNE, EILEEN C (MSN, FNP, CNS)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:C
Last Name:SHERBURNE
Suffix:
Gender:F
Credentials:MSN, FNP, CNS
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Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:MS 616 PO BOX 1997
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3518
Mailing Address - Country:US
Mailing Address - Phone:414-266-2063
Mailing Address - Fax:414-266-3622
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:MS 616
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3518
Practice Address - Country:US
Practice Address - Phone:414-266-2063
Practice Address - Fax:414-266-3622
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI1187-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1194836460Medicaid