Basic Information
| Provider Information | |||||||||
| NPI: | 1609972462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEADOR | ||||||||
| FirstName: | SHERRI | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | CRNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5155 E. EAGLE DRIVE #20730 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852773031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807069430 | ||||||||
| FaxNumber: | 4803782273 | ||||||||
| Practice Location | |||||||||
| Address1: | 4320 E. PRESIDIO STREET #101 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852151165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807069430 | ||||||||
| FaxNumber: | 4803782273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 02/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | RN101426 | AZ | Y | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
ID Information
| ID | Type | State | Issuer | Description | 766678 | 05 | AZ | MEDICAID |