Provider Demographics
NPI:1326333121
Name:DEVRIES, SHERRY LYNN (LM, CPM, CNM, APNP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:LM, CPM, CNM, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FENNIMORE
Mailing Address - State:WI
Mailing Address - Zip Code:53809-1738
Mailing Address - Country:US
Mailing Address - Phone:262-344-1516
Mailing Address - Fax:
Practice Address - Street 1:1040 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FENNIMORE
Practice Address - State:WI
Practice Address - Zip Code:53809-1738
Practice Address - Country:US
Practice Address - Phone:262-344-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9-49176B00000X
IAB-126733176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife