Healthcare Provider Details

I. General information

NPI: 1780748640
Provider Name (Legal Business Name): CHERRY SHERLYN ELMORE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERRY JOHNSON

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5385 FRANKLIN BLVD
SACRAMENTO CA
95820-4717
US

IV. Provider business mailing address

1691 THE ALAMEDA
SAN JOSE CA
95126-2203
US

V. Phone/Fax

Practice location:
  • Phone: 916-452-7305
  • Fax: 916-452-9753
Mailing address:
  • Phone: 408-795-3600
  • Fax: 408-287-0405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20744
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number548255
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number548255
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number548255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: