Provider Demographics
NPI:1629390067
Name:ROBERTS, SHERRY SUE (LPN)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:SUE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 FATTLER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PHILO
Mailing Address - State:OH
Mailing Address - Zip Code:43771-9746
Mailing Address - Country:US
Mailing Address - Phone:740-674-6478
Mailing Address - Fax:
Practice Address - Street 1:540 FATTLER RIDGE RD
Practice Address - Street 2:
Practice Address - City:PHILO
Practice Address - State:OH
Practice Address - Zip Code:43771-9746
Practice Address - Country:US
Practice Address - Phone:740-674-6478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN07456164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse