Provider Demographics
NPI:1639111990
Name:MCSHERRY, DENISE L (DO)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:MCSHERRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 HIGHWAY 59 S
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-4331
Mailing Address - Country:US
Mailing Address - Phone:218-681-4747
Mailing Address - Fax:218-683-2595
Practice Address - Street 1:1720 HIGHWAY 59 S
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-4331
Practice Address - Country:US
Practice Address - Phone:218-681-4747
Practice Address - Fax:218-683-2595
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47239207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN13193Medicaid
MN36337OtherLHS/BANNERHEALTH #
MN24840OtherNDBS #
MN302K2MCOtherMNBS #
MN0704071OtherMEDICA #
MNDA9021042426OtherPREFERRED ONE #
MNHP46693OtherHEALTHPARTNERS #
MN137182OtherUCARE #
MNDA9021042426OtherPREFERRED ONE #
MN36337OtherLHS/BANNERHEALTH #