MEDICARE: SUSAN N SHERMAN R.N.

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	163WS0200X	School Registered Nurse	382828-1	NY

General Provider Information

NPI Number	:	1114280740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN N SHERMAN R.N.

Provider Business Mailing Address
First Line	:	199 LINCOLN ST
Second Line	:
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-1914
Country	:	US
Telephone Number	:	518-775-5715
Fax Number	:	518-773-3674

Provider Business Practice Location Address
First Line	:	199 LINCOLN ST
Second Line	:
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-1914
Country	:	US
Telephone Number	:	518-775-5715
Fax Number	:	518-773-3674

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

Provider Enumeration Date	:	06/19/2012
Last Update Date	:	06/19/2012

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