Provider Demographics
NPI:1891705851
Name:NIDIFFER, SHERI L (DNP)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:L
Last Name:NIDIFFER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7470 SPRING VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-4487
Mailing Address - Country:US
Mailing Address - Phone:703-923-3180
Mailing Address - Fax:703-923-3081
Practice Address - Street 1:7470 SPRING VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-4487
Practice Address - Country:US
Practice Address - Phone:703-923-3180
Practice Address - Fax:703-923-3081
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC01596OtherMEDIC 1 GROUP MEDICARE
0056071496Medicare PIN
Q26084Medicare UPIN