Provider Demographics
NPI:1194868406
Name:AANSTAD, SHERRY (NP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:AANSTAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 ASH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:ID
Mailing Address - Zip Code:83313-5226
Mailing Address - Country:US
Mailing Address - Phone:208-788-4335
Mailing Address - Fax:208-788-0098
Practice Address - Street 1:117 ASH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:ID
Practice Address - Zip Code:83313-5226
Practice Address - Country:US
Practice Address - Phone:208-788-4335
Practice Address - Fax:208-788-0098
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP156A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDNP156AOtherSTATE LICE #