Provider Demographics
NPI:1720140742
Name:VANDER WAL, SHERYL DAWN (WHCNP)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:DAWN
Last Name:VANDER WAL
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1022
Mailing Address - Country:US
Mailing Address - Phone:409-747-0890
Mailing Address - Fax:409-772-0885
Practice Address - Street 1:313 E 12TH ST
Practice Address - Street 2:STE 104
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1954
Practice Address - Country:US
Practice Address - Phone:409-747-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX673129364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174291801Medicaid
TX174291801Medicaid
TXQ24346Medicare UPIN