Provider Demographics
NPI:1063999373
Name:SHEEKS-MEJRI, MISTY MARY ANNE (RN)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:MARY ANNE
Last Name:SHEEKS-MEJRI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:MARY ANNE
Other - Last Name:HUMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:181 BIRCHDALE RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:181 BIRCHDALE RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551
Practice Address - Country:US
Practice Address - Phone:419-276-1584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN431956163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health