Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 17707 | TN |
NPI | 1003256389 |
---|---|
Provider Name | Sydney Wallace Sherrell |
First Address | Knoxville, TN 37920-1545 |
Second Address | Knoxville, TN 37920-1545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2013 |
Last Update Date | 03/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003256389 | RR MEDICARE PIN (01) | TN |
4354347 | BLUECROSS BLUESHIELD (01) | TN |
4745259 | AETNA (01) | TN |
Q000771 | (05) | TN |