Healthcare Provider Details

I. General information

NPI: 1720140742
Provider Name (Legal Business Name): SHERYL DAWN VANDER WAL WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 E 12TH ST STE 104
AUSTIN TX
78701-1954
US

IV. Provider business mailing address

301 UNIVERSITY BLVD
GALVESTON TX
77555-1022
US

V. Phone/Fax

Practice location:
  • Phone: 409-747-0890
  • Fax:
Mailing address:
  • Phone: 409-747-0890
  • Fax: 409-772-0885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number673129
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: