Provider Demographics
NPI:1780748640
Name:ELMORE, CHERRY SHERLYN (FNP)
Entity type:Individual
Prefix:
First Name:CHERRY
Middle Name:SHERLYN
Last Name:ELMORE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHERRY
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-795-3600
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:5385 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-4717
Practice Address - Country:US
Practice Address - Phone:916-452-7305
Practice Address - Fax:916-452-9753
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548255163WC0400X, 163WC1500X, 163WM0102X
CA20744363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR157ZOtherMEDICARE PTAN