Healthcare Provider Details

I. General information

NPI: 1992027650
Provider Name (Legal Business Name): MRS. SHERRYL SWEENEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 414 BOX 1617
APO AE
09173-0017
US

IV. Provider business mailing address

CMR 414 BOX 1617
APO AE
09173-0017
US

V. Phone/Fax

Practice location:
  • Phone: 4909472833117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: