Provider Demographics
NPI:1194020107
Name:MUSSER, SHERRYL CONRAD
Entity type:Individual
Prefix:MRS
First Name:SHERRYL
Middle Name:CONRAD
Last Name:MUSSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17318 SANTA LUCIA ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3118
Mailing Address - Country:US
Mailing Address - Phone:714-299-3088
Mailing Address - Fax:
Practice Address - Street 1:17318 SANTA LUCIA ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3118
Practice Address - Country:US
Practice Address - Phone:714-299-3088
Practice Address - Fax:714-434-6278
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker