Provider Demographics
NPI:1659087138
Name:NORTHWAY, SHERRY (RN)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:NORTHWAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16960 POLK ST
Mailing Address - Street 2:
Mailing Address - City:MILO
Mailing Address - State:IA
Mailing Address - Zip Code:50166-8850
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16960 POLK ST
Practice Address - Street 2:
Practice Address - City:MILO
Practice Address - State:IA
Practice Address - Zip Code:50166-8850
Practice Address - Country:US
Practice Address - Phone:515-975-6796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA114006163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA236Medicaid
IA236OtherVA