Provider Demographics
NPI:1518952399
Name:DERR, SHERRI LYN (MSN CRNP)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:LYN
Last Name:DERR
Suffix:
Gender:F
Credentials:MSN CRNP
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 613
Mailing Address - Street 2:5 SQUIRE LANE
Mailing Address - City:MIFFLINVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18631-0613
Mailing Address - Country:US
Mailing Address - Phone:570-752-1184
Mailing Address - Fax:
Practice Address - Street 1:101 W 9TH ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-3024
Practice Address - Country:US
Practice Address - Phone:570-759-2600
Practice Address - Fax:570-759-3229
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN235197L163WG0000X
PAVP004997B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS62014Medicare UPIN