Provider Demographics
NPI:1578517900
Name:DUBUISSON, SHERRY RENEE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:RENEE
Last Name:DUBUISSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 VALMONT RD
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1309
Mailing Address - Country:US
Mailing Address - Phone:303-440-9320
Mailing Address - Fax:303-440-8769
Practice Address - Street 1:2855 VALMONT RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1309
Practice Address - Country:US
Practice Address - Phone:303-442-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO105881363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48251348Medicaid