Provider Demographics
NPI: | 1659368587 |
---|---|
Name: | PADDEN, SHERRIE (CRNA) |
Entity Type: | Individual |
Prefix: | |
First Name: | SHERRIE |
Middle Name: | |
Last Name: | PADDEN |
Suffix: | |
Gender: | F |
Credentials: | CRNA |
Other - Prefix: | |
Other - First Name: | SHERRIE |
Other - Middle Name: | |
Other - Last Name: | PADDEN |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | CRNA |
Mailing Address - Street 1: | PO BOX 449 |
Mailing Address - Street 2: | |
Mailing Address - City: | MARIETTA |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45750-0449 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 740-374-4500 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 401 MATTHEW ST |
Practice Address - Street 2: | |
Practice Address - City: | MARIETTA |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45750-1635 |
Practice Address - Country: | US |
Practice Address - Phone: | 740-374-1451 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2005-10-05 |
Last Update Date: | 2007-10-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WV | 22361 | 367500000X |
OH | NA-05871 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | |
No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WV | 0069091000 | Medicaid | |
OH | 2186843 | Medicaid | |
WV | 0069091000 | Medicaid |