Provider Demographics
NPI:1649068461
Name:LICHTENWALTER, SHERRY (RN)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:LICHTENWALTER
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:UHRICHSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44683-1709
Mailing Address - Country:US
Mailing Address - Phone:330-231-0868
Mailing Address - Fax:
Practice Address - Street 1:205 ROHR AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3671
Practice Address - Country:US
Practice Address - Phone:330-837-2454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.36440163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)