Provider Demographics
NPI:1225000599
Name:PRIBBERNOW, SHERRY ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:ANN
Last Name:PRIBBERNOW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:SHERRY
Other - Middle Name:ANN
Other - Last Name:BUECHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CCM
Mailing Address - Street 1:W2856 ST CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:CHILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53014
Mailing Address - Country:US
Mailing Address - Phone:920-849-4252
Mailing Address - Fax:
Practice Address - Street 1:W2856 ST CHARLES RD
Practice Address - Street 2:
Practice Address - City:CHILTON
Practice Address - State:WI
Practice Address - Zip Code:53014
Practice Address - Country:US
Practice Address - Phone:920-849-4252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI122198030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39939200Medicaid