Healthcare Provider Details

I. General information

NPI: 1073181475
Provider Name (Legal Business Name): SHERRIE R MAYER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 STONY BROOK DR
LOUISVILLE KY
40220-4014
US

IV. Provider business mailing address

708 AUBURN OAKS DR
LOUISVILLE KY
40214-5686
US

V. Phone/Fax

Practice location:
  • Phone: 502-491-4692
  • Fax: 502-491-4693
Mailing address:
  • Phone: 502-889-9897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SL0600X
TaxonomyLong-Term Care Clinical Nurse Specialist
License Number1110586
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: