Provider Demographics
NPI: | 1922647841 |
---|---|
Name: | HASH, SHERRY DAWN (NP) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | SHERRY |
Middle Name: | DAWN |
Last Name: | HASH |
Suffix: | |
Gender: | F |
Credentials: | NP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 29943 NETWORK PL |
Mailing Address - Street 2: | |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60673-1299 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 317-706-3415 |
Mailing Address - Fax: | 317-706-3417 |
Practice Address - Street 1: | 11595 N MERIDIAN ST STE 401 |
Practice Address - Street 2: | |
Practice Address - City: | CARMEL |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46032-6947 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-706-7246 |
Practice Address - Fax: | 317-706-3417 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2019-12-23 |
Last Update Date: | 2024-01-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 71009557A | 363LF0000X, 363L00000X |
IN | 28251209A | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 300033960 | Medicaid |