Provider Demographics
NPI:1699910232
Name:KORETOFF, SHERI ANN (NP)
Entity type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:ANN
Last Name:KORETOFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SHERI
Other - Middle Name:ANN
Other - Last Name:POPLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:14900 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:KERMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93630-9602
Mailing Address - Country:US
Mailing Address - Phone:559-314-5331
Mailing Address - Fax:
Practice Address - Street 1:9300 VALLEY CHILDRENS PL
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8761
Practice Address - Country:US
Practice Address - Phone:559-353-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003662363L00000X
OK64334363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200241150AMedicaid
OKOK402692Medicare PIN
OKP00788838Medicare PIN