Basic Information
| Provider Information | |||||||||
| NPI: | 1093283939 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHERRILL | ||||||||
| FirstName: | LEE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | RN, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1577 | ||||||||
| Address2: | |||||||||
| City: | DURANT | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747021577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809169140 | ||||||||
| FaxNumber: | 5809169142 | ||||||||
| Practice Location | |||||||||
| Address1: | 1127 S GEORGE NIGH EXPY | ||||||||
| Address2: | |||||||||
| City: | MCALESTER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 745017143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184238440 | ||||||||
| FaxNumber: | 9184212944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2018 | ||||||||
| LastUpdateDate: | 11/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | R0062229 | OK | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.