MEDICARE: SHERRY AANSTAD NP

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	363L00000X	Nurse Practitioner	NP156A	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NP156A	OTHER	ID	STATE LICE #

General Provider Information

NPI Number	:	1194868406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY AANSTAD NP

Provider Business Mailing Address
First Line	:	117 ASH ST
Second Line	:
City	:	BELLEVUE
State	:	ID
Zip	:	83313-5226
Country	:	US
Telephone Number	:	208-788-4335
Fax Number	:	208-788-0098

Provider Business Practice Location Address
First Line	:	117 ASH ST
Second Line	:
City	:	BELLEVUE
State	:	ID
Zip	:	83313-5226
Country	:	US
Telephone Number	:	208-788-4335
Fax Number	:	208-788-0098

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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