Healthcare Provider Details

I. General information

NPI: 1639690118
Provider Name (Legal Business Name): SHERRY LYNN DALTON APRN-CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERRY LYNN PERSINGER

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PENNSYLVANIA AVE
CHARLESTON WV
25302-3351
US

IV. Provider business mailing address

800 PENNSYLVANIA AVE
CHARLESTON WV
25302-3351
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-2278
  • Fax: 304-388-2294
Mailing address:
  • Phone: 304-388-2278
  • Fax: 304-388-2294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN57276-CRNA
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: