Healthcare Provider Details

I. General information

NPI: 1508051285
Provider Name (Legal Business Name): SHERRIE LYNNE CRISS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13250 HAZEL DELL PKWY SUITE 103
CARMEL IN
46033-8521
US

IV. Provider business mailing address

13250 HAZEL DELL PKWY SUITE 103
CARMEL IN
46033-8521
US

V. Phone/Fax

Practice location:
  • Phone: 317-843-9475
  • Fax: 317-843-9476
Mailing address:
  • Phone: 317-843-9475
  • Fax: 317-843-9476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number28080748A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: