Healthcare Provider Details

I. General information

NPI: 1497129415
Provider Name (Legal Business Name): SHERRI RENEE WHITE MSN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 W WASHINGTON ST
PITTSFIELD IL
62363-1350
US

IV. Provider business mailing address

640 W WASHINGTON ST
PITTSFIELD IL
62363-1350
US

V. Phone/Fax

Practice location:
  • Phone: 217-285-2113
  • Fax: 217-285-9623
Mailing address:
  • Phone: 217-285-2113
  • Fax: 217-285-9623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209013546
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: