Provider Demographics
NPI:1316279532
Name:ROSS, SHERRY A (FNP-BC, MSN)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:A
Last Name:ROSS
Suffix:
Gender:F
Credentials:FNP-BC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 E. 20TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105
Mailing Address - Country:US
Mailing Address - Phone:605-334-6730
Mailing Address - Fax:605-731-2579
Practice Address - Street 1:910 E. 20TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-334-6730
Practice Address - Fax:605-731-2579
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000698363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1316279532Medicaid