Provider Demographics
NPI:1194275735
Name:CLANCY, SHERRIE (LPN)
Entity type:Individual
Prefix:
First Name:SHERRIE
Middle Name:
Last Name:CLANCY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 CURTIS PL
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1916
Mailing Address - Country:US
Mailing Address - Phone:315-730-2169
Mailing Address - Fax:
Practice Address - Street 1:131 CURTIS PL
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1916
Practice Address - Country:US
Practice Address - Phone:315-730-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10 282627164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse