Provider Demographics
NPI:1699835439
Name:CARROLL, SHERRY ANNE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:ANNE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 LIGHTNING WAY
Mailing Address - Street 2:
Mailing Address - City:CAMANO ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98282-8349
Mailing Address - Country:US
Mailing Address - Phone:360-629-6042
Mailing Address - Fax:360-629-6042
Practice Address - Street 1:9522 271ST ST NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-8095
Practice Address - Country:US
Practice Address - Phone:360-629-0800
Practice Address - Fax:360-629-6042
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014283174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist