Provider Demographics
NPI:1134715337
Name:FOSS, SHERRIE ANNE
Entity type:Individual
Prefix:
First Name:SHERRIE
Middle Name:ANNE
Last Name:FOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9395 FOREST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-8298
Mailing Address - Country:US
Mailing Address - Phone:815-222-2639
Mailing Address - Fax:
Practice Address - Street 1:2278 S MADISON RD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-8623
Practice Address - Country:US
Practice Address - Phone:608-751-6078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25740630163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health