Provider Demographics
NPI:1912147398
Name:CORRELL, SHERYL DIANE (LMP)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:DIANE
Last Name:CORRELL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-3133
Mailing Address - Country:US
Mailing Address - Phone:360-734-9525
Mailing Address - Fax:
Practice Address - Street 1:1810 BROADWAY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3133
Practice Address - Country:US
Practice Address - Phone:360-734-9525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006149174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist