Provider Demographics
NPI:1588944391
Name:SKINNER, SHERRY (LPN)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:SKINNER
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 1:40 PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13316-1216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:228 8TH AVENUE
Practice Address - Street 2:
Practice Address - City:SYLVAN BEACH
Practice Address - State:NY
Practice Address - Zip Code:13157-1216
Practice Address - Country:US
Practice Address - Phone:315-762-0146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174399-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse