Basic Information
| Provider Information | |||||||||
| NPI: | 1134596562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUISMAN | ||||||||
| FirstName: | SHERRY | ||||||||
| MiddleName: | RAE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 N HENSON ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812355134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9709442331 | ||||||||
| FaxNumber: | 9709442320 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 N HENSON ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CITY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812355134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9709442331 | ||||||||
| FaxNumber: | 9709442320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2015 | ||||||||
| LastUpdateDate: | 10/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APN.0991930-NP | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.