Provider Demographics
NPI:1396852596
Name:SHERWOOD, NANCY H (PA-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:H
Last Name:SHERWOOD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:414-283-8444
Mailing Address - Fax:
Practice Address - Street 1:1575 N RIVERCENTER DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3978
Practice Address - Country:US
Practice Address - Phone:414-283-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI627-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42931000Medicaid
WI019940681Medicare PIN
WI004173903Medicare PIN
S54306Medicare UPIN
WI462364902Medicare PIN