Provider Demographics
NPI:1508296039
Name:MOUNCE, SHERIL LOUISE
Entity Type:Individual
Prefix:MRS
First Name:SHERIL
Middle Name:LOUISE
Last Name:MOUNCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 NE F ST # 221A
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2300
Mailing Address - Country:US
Mailing Address - Phone:541-778-0073
Mailing Address - Fax:
Practice Address - Street 1:1301 NE 6TH ST STE D
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1277
Practice Address - Country:US
Practice Address - Phone:541-778-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR217171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor