Healthcare Provider Details

I. General information

NPI: 1831749662
Provider Name (Legal Business Name): HANNAH E SHERIDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 DUFF AVE
AMES IA
50010-5745
US

IV. Provider business mailing address

1215 DUFF AVE
AMES IA
50010-5469
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-4401
  • Fax: 515-239-4791
Mailing address:
  • Phone: 515-239-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number107062
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: