Provider Demographics
NPI:1336627405
Name:SHERWOOD, JEANNIE ELAINE (RN)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:ELAINE
Last Name:SHERWOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 VZCR 3204
Mailing Address - Street 2:
Mailing Address - City:WILLS POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75169
Mailing Address - Country:US
Mailing Address - Phone:870-828-0594
Mailing Address - Fax:
Practice Address - Street 1:251 VZCR 3204
Practice Address - Street 2:
Practice Address - City:WILLS POINT
Practice Address - State:TX
Practice Address - Zip Code:75169
Practice Address - Country:US
Practice Address - Phone:870-828-0594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX868490163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse