Healthcare Provider Details

I. General information

NPI: 1679343396
Provider Name (Legal Business Name): SHERRI L GARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 CONSTITUTION AVE NE STE G
ALBUQUERQUE NM
87112-5755
US

IV. Provider business mailing address

12000 CONSTITUTION AVE NE STE G
ALBUQUERQUE NM
87112-5755
US

V. Phone/Fax

Practice location:
  • Phone: 505-859-8047
  • Fax:
Mailing address:
  • Phone: 505-859-8047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: