Provider Demographics
NPI:1720218431
Name:SHERIDAN, REBECCA LYNN GRINSELL (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN GRINSELL
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BASSETT ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:4076 NEELY ROAD
Mailing Address - City:FT. WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703
Mailing Address - Country:US
Mailing Address - Phone:907-361-5356
Mailing Address - Fax:907-361-4809
Practice Address - Street 1:NNMC
Practice Address - Street 2:8901 WISCONSIN AVE C/O OBGYN
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5600
Practice Address - Country:US
Practice Address - Phone:202-812-9502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249803207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology