Provider Demographics
NPI:1215623327
Name:SHERRY, CARMEN MICHELLE (CRNP)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:MICHELLE
Last Name:SHERRY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2382 BALD EAGLE PIKE
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-7718
Mailing Address - Country:US
Mailing Address - Phone:814-931-9504
Mailing Address - Fax:
Practice Address - Street 1:501 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4810
Practice Address - Country:US
Practice Address - Phone:814-944-2107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN577159363L00000X
PASP027619363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner