Provider Demographics
NPI:1790220424
Name:HUBER, SHERRY RENEE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:RENEE
Last Name:HUBER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:SHERRY
Other - Middle Name:RENEE
Other - Last Name:WALKOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1075 N CURTIS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1348
Mailing Address - Country:US
Mailing Address - Phone:208-377-5166
Mailing Address - Fax:
Practice Address - Street 1:1075 N CURTIS RD STE 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1348
Practice Address - Country:US
Practice Address - Phone:208-377-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP4924363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily