Provider Demographics
NPI:1376989954
Name:SHERRY, ANN MARIE (MS RD CD)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:SHERRY
Suffix:
Gender:F
Credentials:MS RD CD
Other - Prefix:MISS
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:STERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:5000 W. CHAMBERS ST.
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1688
Mailing Address - Country:US
Mailing Address - Phone:414-447-3686
Mailing Address - Fax:414-874-4121
Practice Address - Street 1:5000 W. CHAMBERS ST.
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1688
Practice Address - Country:US
Practice Address - Phone:414-447-3686
Practice Address - Fax:414-874-4121
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI530875133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered