MEDICARE: MS. SHERRIE R. LANDSEM WALFORD MT

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	247ZC0005X	Clinical Laboratory Director (Non-physician)		ND

General Provider Information

NPI Number	:	1174749501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHERRIE R. LANDSEM WALFORD MT

Provider Business Mailing Address
First Line	:	1100 AVENUE A
Second Line	:
City	:	DEVILS LAKE
State	:	ND
Zip	:	58301-6002
Country	:	US
Telephone Number	:	701-662-0213
Fax Number	:

Provider Business Practice Location Address
First Line	:	3883 74TH AVENUE NE
Second Line	:	BOX 309
City	:	FORT TOTTEN
State	:	ND
Zip	:	58335-0309
Country	:	US
Telephone Number	:	701-766-1600
Fax Number	:	701-766-1640

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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