Provider Demographics
NPI:1124478466
Name:JAMES, SHERELLE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:SHERELLE
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2097 HAMPSTEAD DR S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-9111
Mailing Address - Country:US
Mailing Address - Phone:614-783-6401
Mailing Address - Fax:
Practice Address - Street 1:2637 SHERBORNE CRES
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-1771
Practice Address - Country:US
Practice Address - Phone:614-783-6401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.161956-M-IV164W00000X
OHRN.459742163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0203889Medicaid