Healthcare Provider Details

I. General information

NPI: 1376240481
Provider Name (Legal Business Name): SHERRIE CARNICLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14362 N FRANK LLOYD WRIGHT BLVD STE B111
SCOTTSDALE AZ
85260-8881
US

IV. Provider business mailing address

13440 N 44TH ST APT 2227
PHOENIX AZ
85032-6359
US

V. Phone/Fax

Practice location:
  • Phone: 866-578-2693
  • Fax:
Mailing address:
  • Phone: 952-426-8839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: