Healthcare Provider Details

I. General information

NPI: 1831676048
Provider Name (Legal Business Name): SHERRY SWEIKERT-SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 17TH ST
LEWISTON ID
83501-3652
US

IV. Provider business mailing address

PO BOX 341
LEWISTON ID
83501-0341
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-8416
  • Fax:
Mailing address:
  • Phone: 208-743-8416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number59206
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: