Healthcare Provider Details

I. General information

NPI: 1649683756
Provider Name (Legal Business Name): SHERRI ZDZIARSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W 5TH ST STE C
SHERIDAN WY
82801-2749
US

IV. Provider business mailing address

909 LONG DR STE C
SHERIDAN WY
82801-3282
US

V. Phone/Fax

Practice location:
  • Phone: 307-674-5534
  • Fax:
Mailing address:
  • Phone: 307-672-8958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number25178
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: