Healthcare Provider Details

I. General information

NPI: 1588085716
Provider Name (Legal Business Name): SHERRI KLENCZAR CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 05/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 STONE ST
PORT HURON MI
48060-3520
US

IV. Provider business mailing address

1321 STONE ST
PORT HURON MI
48060-3520
US

V. Phone/Fax

Practice location:
  • Phone: 810-984-1000
  • Fax:
Mailing address:
  • Phone: 810-984-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704243691
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: