MEDICARE: SHERRY ANN HENRY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN154648	GA
2	163W00000X	Registered Nurse	1-108353	AL

General Provider Information

NPI Number	:	1023268844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY ANN HENRY RN

Provider Business Mailing Address
First Line	:	5918 BUSH AVE
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-3968
Country	:	US
Telephone Number	:	170-639-3253
Fax Number	:

Provider Business Practice Location Address
First Line	:	4141 N MIAMI AVE STE 209
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33127-2868
Country	:	US
Telephone Number	:	130-543-9121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	09/29/2008

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