Provider Demographics
NPI:1770027799
Name:LIM, SHERRY (LAC, EAMP, MSOM)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:LAC, EAMP, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NW 20TH AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1947
Mailing Address - Country:US
Mailing Address - Phone:360-836-0919
Mailing Address - Fax:360-984-6580
Practice Address - Street 1:513 N MORRISON RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664
Practice Address - Country:US
Practice Address - Phone:360-836-0919
Practice Address - Fax:360-984-6580
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60706393171100000X
ORAC180071171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist