Provider Demographics
NPI:1235608928
Name:SHAW, SHERRI (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:90152 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-7514
Mailing Address - Country:US
Mailing Address - Phone:308-631-4155
Mailing Address - Fax:
Practice Address - Street 1:3350 10TH ST
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-1724
Practice Address - Country:US
Practice Address - Phone:308-635-3089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-25
Last Update Date:2018-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY40173.1812363LP0808X
NE112630363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health