Provider Demographics
NPI:1679680227
Name:DRESS, SHERRY LEE (LDM, CPM)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LEE
Last Name:DRESS
Suffix:
Gender:F
Credentials:LDM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25198 HWY 395 S
Mailing Address - Street 2:
Mailing Address - City:CANYON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97820-8700
Mailing Address - Country:US
Mailing Address - Phone:541-575-0962
Mailing Address - Fax:541-575-0962
Practice Address - Street 1:25198 HWY 395 S
Practice Address - Street 2:
Practice Address - City:CANYON CITY
Practice Address - State:OR
Practice Address - Zip Code:97820-8700
Practice Address - Country:US
Practice Address - Phone:541-575-0962
Practice Address - Fax:541-575-0962
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0618133698175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR140413Medicaid