Healthcare Provider Details

I. General information

NPI: 1467428862
Provider Name (Legal Business Name): SHERRILL LEE HOLMES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 FAIRVIEW BLVD
RED WING MN
55066-2848
US

IV. Provider business mailing address

246 WESTWOOD SOUTH ST
WELCH MN
55089-5002
US

V. Phone/Fax

Practice location:
  • Phone: 651-267-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number40361
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: