Provider Demographics
NPI:1588765655
Name:RISLEY, SHERRY ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:ANN
Last Name:RISLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:REA CLINIC
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-2571
Practice Address - Street 1:27 CIRCLE
Practice Address - Street 2:ZEIGLER COMMUNITY HEALTH CENTER
Practice Address - City:ZEIGLER
Practice Address - State:IL
Practice Address - Zip Code:62999
Practice Address - Country:US
Practice Address - Phone:618-596-2411
Practice Address - Fax:618-596-6559
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse