Provider Demographics
NPI:1669551305
Name:MOTTO, SHERRY E (CRNA)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:E
Last Name:MOTTO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:
Practice Address - Street 1:5091 W BETHEL AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-8511
Practice Address - Country:US
Practice Address - Phone:765-286-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402718-1367500000X
IN28171266A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000667522OtherANTHEM PROVIDER NUMBER
IN200849250Medicaid
INP00843962Medicare PIN
NYRA5933Medicare PIN
IN815500191Medicare PIN
IN000000667522OtherANTHEM PROVIDER NUMBER
IN200849250Medicaid
INM400044963Medicare PIN
INM400070961Medicare PIN
INM400015504Medicare PIN