Provider Demographics
NPI:1639231053
Name:FROMMER SHERBOW, UTE (CNM NP MSN)
Entity Type:Individual
Prefix:MRS
First Name:UTE
Middle Name:
Last Name:FROMMER SHERBOW
Suffix:
Gender:F
Credentials:CNM NP MSN
Other - Prefix:
Other - First Name:UTE
Other - Middle Name:F
Other - Last Name:SHERBOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NMNP, MSN
Mailing Address - Street 1:312 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540
Mailing Address - Country:US
Mailing Address - Phone:541-535-9108
Mailing Address - Fax:541-535-8809
Practice Address - Street 1:312 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540
Practice Address - Country:US
Practice Address - Phone:541-535-9108
Practice Address - Fax:541-535-8809
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR86000353363LW0102X
86000353367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
R165561OtherMEDICARE
OR150069Medicaid