Provider Demographics
NPI:1558817163
Name:THEBERGE, SHERRI LYNN (RN, IBCLC, LMT, CD)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:LYNN
Last Name:THEBERGE
Suffix:
Gender:F
Credentials:RN, IBCLC, LMT, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HOXSIE AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-1444
Mailing Address - Country:US
Mailing Address - Phone:340-514-3299
Mailing Address - Fax:
Practice Address - Street 1:60 HOXSIE AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-1444
Practice Address - Country:US
Practice Address - Phone:340-514-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI11157163W00000X, 163WM0102X, 163WM1400X, 163WL0100X
VI8125-26374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No374J00000XNursing Service Related ProvidersDoula