Provider Demographics
NPI:1578062048
Name:STANTON, SHERRY LYNN (NP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:STANTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9858 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-5210
Mailing Address - Country:US
Mailing Address - Phone:208-286-9471
Mailing Address - Fax:208-286-0565
Practice Address - Street 1:9858 W STATE ST
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669-5210
Practice Address - Country:US
Practice Address - Phone:208-286-9471
Practice Address - Fax:208-286-0565
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175932363LF0000X
ID57869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily