Healthcare Provider Details

I. General information

NPI: 1073891149
Provider Name (Legal Business Name): CHARNAI DAWN SHERRY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARNAI DAWN FANKHANEL PA-C

II. Dates (important events)

Enumeration Date: 07/23/2011
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 W KINNICKINNIC RIVER PKWY STE 507
MILWAUKEE WI
53215
US

IV. Provider business mailing address

2901 W KINNICKINNIC RIVER PKWY STE 507
MILWAUKEE WI
53215-3677
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-3780
  • Fax: 414-649-3794
Mailing address:
  • Phone: 414-649-3780
  • Fax: 414-649-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2808
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2808-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: