Healthcare Provider Details

I. General information

NPI: 1518476191
Provider Name (Legal Business Name): SHERRY L MEWES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 09/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 NW 10TH ST STE A
FAIRFIELD IL
62837-1219
US

IV. Provider business mailing address

213 NW 10TH ST STE A
FAIRFIELD IL
62837-1219
US

V. Phone/Fax

Practice location:
  • Phone: 618-842-4617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209016573
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: