Healthcare Provider Details

I. General information

NPI: 1740193895
Provider Name (Legal Business Name): SHERRY A GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 9TH ST N
PARK FALLS WI
54552-1384
US

IV. Provider business mailing address

N16296 KALEY RD
BUTTERNUT WI
54514-8758
US

V. Phone/Fax

Practice location:
  • Phone: 715-762-2474
  • Fax: 715-762-2428
Mailing address:
  • Phone: 765-760-4274
  • Fax: 715-762-2428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number152756-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: