Provider Demographics
NPI:1457536229
Name:SHERWOOD, PENNY L (RN, BSN)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:L
Last Name:SHERWOOD
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 W HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48357-4208
Mailing Address - Country:US
Mailing Address - Phone:248-887-3436
Mailing Address - Fax:
Practice Address - Street 1:1255 N OAKLAND BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1582
Practice Address - Country:US
Practice Address - Phone:248-406-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-29
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704106898163WA0400X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)