MEDICARE: MRS. SHERRI DOUGLAS 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	RN.353943	OH

General Provider Information

NPI Number	:	1285059311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERRI DOUGLAS R.N.

Provider Business Mailing Address
First Line	:	1100 SUPERIOR AVE E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2530
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 SUPERIOR AVE E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2530
Country	:	US
Telephone Number	:	216-482-2890
Fax Number	:

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

Provider Enumeration Date	:	02/26/2014
Last Update Date	:	02/26/2014

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