Provider Demographics
NPI:1588314041
Name:WYLIE, SHERRILL SMITH (RN)
Entity type:Individual
Prefix:MS
First Name:SHERRILL
Middle Name:SMITH
Last Name:WYLIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 ADAMS RUN RD
Mailing Address - Street 2:
Mailing Address - City:NEW PARIS
Mailing Address - State:PA
Mailing Address - Zip Code:15554-8807
Mailing Address - Country:US
Mailing Address - Phone:814-494-2341
Mailing Address - Fax:
Practice Address - Street 1:3281 QUAKER VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:FISHERTOWN
Practice Address - State:PA
Practice Address - Zip Code:15539
Practice Address - Country:US
Practice Address - Phone:814-839-4195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN266208L163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice