Healthcare Provider Details

I. General information

NPI: 1982921326
Provider Name (Legal Business Name): SHERRI L. HAVEN MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERRI L. GENTRY MSN, FNP-C

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 THORPSHIRE DR
RALEIGH NC
27615-3739
US

IV. Provider business mailing address

2000 THORPSHIRE DR
RALEIGH NC
27615-3739
US

V. Phone/Fax

Practice location:
  • Phone: 919-522-5998
  • Fax:
Mailing address:
  • Phone: 919-522-5998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201967
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: