Provider Demographics
NPI:1225329600
Name:DESMOND, SHERI (CNP)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:
Last Name:DESMOND
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 JEFFERSON AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7101
Mailing Address - Country:US
Mailing Address - Phone:419-251-1963
Mailing Address - Fax:419-251-8765
Practice Address - Street 1:3930 SUNFOREST CT
Practice Address - Street 2:SUITE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4527
Practice Address - Country:US
Practice Address - Phone:419-251-8760
Practice Address - Fax:419-251-8765
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 09602 NP363LA2200X
MI4704214586363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCOA09602NPOtherOH CNP LICENSE
MI1225329600Medicaid
OH0056825Medicaid
OHCOA09602NPOtherOH CNP LICENSE