Provider Demographics
NPI:1194936302
Name:WILLIAMSON, SHERRY LYNN (LPN)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:LYNN
Last Name:WILLIAMSON
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 1:2600 PARKER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PEEBLES
Mailing Address - State:OH
Mailing Address - Zip Code:45660-9104
Mailing Address - Country:US
Mailing Address - Phone:937-588-4606
Mailing Address - Fax:
Practice Address - Street 1:2600 PARKER RIDGE RD
Practice Address - Street 2:
Practice Address - City:PEEBLES
Practice Address - State:OH
Practice Address - Zip Code:45660-9104
Practice Address - Country:US
Practice Address - Phone:937-588-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN092065164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2373006Medicaid