Healthcare Provider Details

I. General information

NPI: 1790132421
Provider Name (Legal Business Name): PORSCHIA N SHERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 GOLF COURSE RD NW APT 1213
ALBUQUERQUE NM
87114-3917
US

IV. Provider business mailing address

10300 GOLF COURSE RD NW APT 1213
ALBUQUERQUE NM
87114-3917
US

V. Phone/Fax

Practice location:
  • Phone: 505-553-6669
  • Fax:
Mailing address:
  • Phone: 505-553-6669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: