Healthcare Provider Details

I. General information

NPI: 1689204380
Provider Name (Legal Business Name): SHERRY LYNN WERTH MSN, RN, CWOCN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

PO BOX 30480
LANSING MI
48909-7980
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-2687
  • Fax: 517-364-2632
Mailing address:
  • Phone: 517-364-2687
  • Fax: 517-364-2632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4704136800
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: