Healthcare Provider Details

I. General information

NPI: 1033397658
Provider Name (Legal Business Name): SHERYL E LEARY MS RN CNS CCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 FORD RD
CARMEL VALLEY CA
93924-9662
US

IV. Provider business mailing address

76 FORD RD
CARMEL VALLEY CA
93924-9662
US

V. Phone/Fax

Practice location:
  • Phone: 831-298-7007
  • Fax:
Mailing address:
  • Phone: 831-298-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number466267
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number2156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: