Healthcare Provider Details

I. General information

NPI: 1619302809
Provider Name (Legal Business Name): SHERI L FLOYD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERI L. JUCAWICZ

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST
BETHLEHEM PA
18015-1065
US

IV. Provider business mailing address

255 W MICHIGAN AVE PO BOX 1123
JACKSON MI
49201-2218
US

V. Phone/Fax

Practice location:
  • Phone: 610-954-5810
  • Fax: 610-954-5480
Mailing address:
  • Phone: 517-787-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN517568L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: