Provider Demographics
NPI:1699085464
Name:DAVIS, SHERRI M (PA)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:M
Other - Last Name:ELSWORTHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:725 SCHOOL ST STE A
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1207
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-9128
Practice Address - Street 1:27240 W SAXONY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CHANNAHON
Practice Address - State:IL
Practice Address - Zip Code:60410-1416
Practice Address - Country:US
Practice Address - Phone:815-467-1518
Practice Address - Fax:815-467-7419
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85003880363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085003880OtherIL LICENSE