Healthcare Provider Details

I. General information

NPI: 1649006248
Provider Name (Legal Business Name): SHERYL HAIR RN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4610 E SOUTHCROSS BLVD
SAN ANTONIO TX
78222-4914
US

IV. Provider business mailing address

100 N SANTA ROSA APT 613
SAN ANTONIO TX
78207-3265
US

V. Phone/Fax

Practice location:
  • Phone: 210-648-1491
  • Fax:
Mailing address:
  • Phone: 210-396-9992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number564470
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: