Provider Demographics
NPI:1588655344
Name:BAZE, SHERRY LEA (CPNP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LEA
Last Name:BAZE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:LEA
Other - Last Name:NAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2313 PARK LN
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-4856
Mailing Address - Country:US
Mailing Address - Phone:515-223-6252
Mailing Address - Fax:
Practice Address - Street 1:808 5TH AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1315
Practice Address - Country:US
Practice Address - Phone:515-244-2267
Practice Address - Fax:515-244-1922
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC-041379363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics