Provider Demographics
NPI:1295108421
Name:ANDERSON, SHERYL ELAINE (PA-C)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:ELAINE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864 WILDFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-5007
Mailing Address - Country:US
Mailing Address - Phone:218-340-4534
Mailing Address - Fax:
Practice Address - Street 1:1425 MAIN ST N
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-6026
Practice Address - Country:US
Practice Address - Phone:320-629-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant