Healthcare Provider Details

I. General information

NPI: 1205608601
Provider Name (Legal Business Name): SHERWIN LLACER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 BLUEBERRY LN APT 104
BELLINGHAM WA
98229-2820
US

IV. Provider business mailing address

817 BLUEBERRY LN APT 104
BELLINGHAM WA
98229-2820
US

V. Phone/Fax

Practice location:
  • Phone: 408-726-0061
  • Fax:
Mailing address:
  • Phone: 408-726-0061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60283963
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: