Provider Demographics
NPI:1508289067
Name:SHERRELL, JAMIE (LMP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:SHERRELL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:DAWN
Other - Last Name:BRUNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9720 N NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-5019
Mailing Address - Country:US
Mailing Address - Phone:509-646-2273
Mailing Address - Fax:509-464-0392
Practice Address - Street 1:9720 N NEVADA ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-5019
Practice Address - Country:US
Practice Address - Phone:509-646-2273
Practice Address - Fax:509-464-0392
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60446354225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist