Provider Demographics
NPI:1396538666
Name:PEDERSEN, SHERRY LYNN
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:PEDERSEN
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 1:3120 WILLIT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68112-1748
Mailing Address - Country:US
Mailing Address - Phone:402-612-4226
Mailing Address - Fax:
Practice Address - Street 1:5156 S 124TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2129
Practice Address - Country:US
Practice Address - Phone:402-612-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion