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NPI Code Detail

MEDICARE: SHERRY LANE GUNN

MEDICARE: SHERRY LANE GUNN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental Hygienist21451CA

General Provider Information

NPI Number : 1659888105
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHERRY LANE GUNN
Provider Business Mailing Address
First Line : 6403 BRANDO LOOP
Second Line :
City : FAIR OAKS
State : CA
Zip : 95628-3764
Country : US
Telephone Number : 916-969-5853
Fax Number :
Provider Business Practice Location Address
First Line : 555 FREMONT ST
Second Line :
City : COLUSA
State : CA
Zip : 95932-2534
Country : US
Telephone Number : 530-458-8635
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2018
Last Update Date : 01/05/2018

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Directions to “ SHERRY LANE GUNN ” Practice Location

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