Healthcare Provider Details

I. General information

NPI: 1235113606
Provider Name (Legal Business Name): JEAN L SHERMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 CHASE AVE COUMADIN/WOUND CLINIC
WALLA WALLA WA
99362-2924
US

IV. Provider business mailing address

PO BOX 34439
SEATTLE WA
98124-1439
US

V. Phone/Fax

Practice location:
  • Phone: 509-529-8933
  • Fax: 509-522-5119
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30004292
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00061850
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: