Provider Demographics
NPI:1104122829
Name:BURNAM, SHERRY ANN (CNM)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:ANN
Last Name:BURNAM
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 PINELAND DR STE 300A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5300
Mailing Address - Country:US
Mailing Address - Phone:214-221-0855
Mailing Address - Fax:
Practice Address - Street 1:5750 PINELAND DR STE 300A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5300
Practice Address - Country:US
Practice Address - Phone:214-221-0855
Practice Address - Fax:239-343-7185
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115159367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113187600Medicaid