Healthcare Provider Details

I. General information

NPI: 1154671527
Provider Name (Legal Business Name): SHERRY WASHBURN MSN, RN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 E PARIS AVE SE STE 200
GRAND RAPIDS MI
49546-3682
US

IV. Provider business mailing address

1179 E PARIS AVE SE STE 150
GRAND RAPIDS MI
49546-8373
US

V. Phone/Fax

Practice location:
  • Phone: 616-455-9450
  • Fax: 616-455-5221
Mailing address:
  • Phone: 616-455-9450
  • Fax: 616-455-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704143371
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704143371
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: