Healthcare Provider Details

I. General information

NPI: 1124036207
Provider Name (Legal Business Name): MRS. SHERRY ELIZABETH WOMBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 VETERANS DR
HARRISBURG IL
62946-3320
US

IV. Provider business mailing address

20 VETERANS DR
HARRISBURG IL
62946-3320
US

V. Phone/Fax

Practice location:
  • Phone: 618-252-2452
  • Fax: 618-294-8413
Mailing address:
  • Phone: 618-252-2452
  • Fax: 618-294-8413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2786
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: