Provider Demographics
NPI:1508385865
Name:SHEREK, BECKY SUE (RN)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:SUE
Last Name:SHEREK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 18TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EVELETH
Mailing Address - State:MN
Mailing Address - Zip Code:55734-1100
Mailing Address - Country:US
Mailing Address - Phone:218-750-0860
Mailing Address - Fax:218-744-2133
Practice Address - Street 1:603 9TH ST N
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2319
Practice Address - Country:US
Practice Address - Phone:218-750-0860
Practice Address - Fax:218-744-9940
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12965163WC1500X
MN1270729163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health