MEDICARE: SHERRIE LYNNE CRISS 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	363LP0200X	Pediatric Nurse Practitioner	28080748A	IN

General Provider Information

NPI Number	:	1508051285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRIE LYNNE CRISS NP

Provider Business Mailing Address
First Line	:	13250 HAZEL DELL PKWY
Second Line	:	SUITE 103
City	:	CARMEL
State	:	IN
Zip	:	46033-8521
Country	:	US
Telephone Number	:	317-843-9475
Fax Number	:	317-843-9476

Provider Business Practice Location Address
First Line	:	13250 HAZEL DELL PKWY
Second Line	:	SUITE 103
City	:	CARMEL
State	:	IN
Zip	:	46033-8521
Country	:	US
Telephone Number	:	317-843-9475
Fax Number	:	317-843-9476

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

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/06/2007

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