Provider Demographics
NPI:1801932595
Name:STEVENS, SHERRY ANNE (CPM, MHCM)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:ANNE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:CPM, MHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 WINONA RD
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-6009
Mailing Address - Country:US
Mailing Address - Phone:603-279-4197
Mailing Address - Fax:
Practice Address - Street 1:124 WINONA RD
Practice Address - Street 2:
Practice Address - City:MEREDITH
Practice Address - State:NH
Practice Address - Zip Code:03253-6009
Practice Address - Country:US
Practice Address - Phone:603-279-4197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1018207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30462183Medicaid