Provider Demographics
NPI:1952497430
Name:SHERLOCK, ELIZABETH (PNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SHERLOCK
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:582 ROOSEVELT TRAIL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04075
Practice Address - Country:US
Practice Address - Phone:207-829-3233
Practice Address - Fax:207-893-0752
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81664363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME254690099Medicaid
S59785Medicare UPIN
ME254690099Medicaid