Provider Demographics
NPI:1306154893
Name:GRIEPENSTROH, SHERRY L (NP)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:GRIEPENSTROH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:L
Other - Last Name:RANSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2514
Mailing Address - Country:US
Mailing Address - Phone:812-482-2345
Mailing Address - Fax:
Practice Address - Street 1:800 W 9TH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2514
Practice Address - Country:US
Practice Address - Phone:812-482-2345
Practice Address - Fax:812-450-4855
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003409A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100182430Medicaid
KY7100182430Medicaid