Provider Demographics
NPI:1396122719
Name:SHERK, FOREST ANN (MOTR)
Entity type:Individual
Prefix:MRS
First Name:FOREST
Middle Name:ANN
Last Name:SHERK
Suffix:
Gender:F
Credentials:MOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5870 COURTYARD CRES
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-3152
Mailing Address - Country:US
Mailing Address - Phone:574-261-1820
Mailing Address - Fax:
Practice Address - Street 1:5404 GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-3781
Practice Address - Country:US
Practice Address - Phone:317-291-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004723A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist