Healthcare Provider Details

I. General information

NPI: 1760451397
Provider Name (Legal Business Name): SHERRI ANN BRANDENBURG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHERRI ANN LAHA

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 BOXWOOD CIR
DE PERE WI
54115-7305
US

IV. Provider business mailing address

2702 BOXWOOD CIR
DE PERE WI
54115-7305
US

V. Phone/Fax

Practice location:
  • Phone: 920-445-4452
  • Fax:
Mailing address:
  • Phone: 920-445-4452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number138923-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: