Healthcare Provider Details

I. General information

NPI: 1770037558
Provider Name (Legal Business Name): JERAH SHERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W BERGER ST
SANTA FE NM
87505-2616
US

IV. Provider business mailing address

108 W BERGER ST
SANTA FE NM
87505-2616
US

V. Phone/Fax

Practice location:
  • Phone: 575-519-2374
  • Fax:
Mailing address:
  • Phone: 575-519-2374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberX-09642
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: