MEDICARE: MS. SHERRY ANN SPILLERS RN

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	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	045358	LA

General Provider Information

NPI Number	:	1871693655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHERRY ANN SPILLERS RN

Provider Business Mailing Address
First Line	:	5899 HWY 143
Second Line	:
City	:	STERLINGTON
State	:	LA
Zip	:	71280
Country	:	US
Telephone Number	:	318-362-5189
Fax Number	:	318-362-5428

Provider Business Practice Location Address
First Line	:	4781 SOUTH GRAND ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202
Country	:	US
Telephone Number	:	318-362-5189
Fax Number	:	318-362-5428

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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