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
State | License ID | Taxonomies |
---|---|---|
OH | COA 09602 NP | 363LA2200X |
MI | 4704214586 | 363LA2200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | COA09602NP | Other | OH CNP LICENSE |
MI | 1225329600 | Medicaid | |
OH | 0056825 | Medicaid | |
OH | COA09602NP | Other | OH CNP LICENSE |