Provider Demographics
NPI:1184258063
Name:BRASCH, SHERRY LYN
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYN
Last Name:BRASCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:LYN
Other - Last Name:MAAHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:579 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-7713
Mailing Address - Country:US
Mailing Address - Phone:920-810-5255
Mailing Address - Fax:
Practice Address - Street 1:579 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-7713
Practice Address - Country:US
Practice Address - Phone:920-810-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310573-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse