1770869737 NPI number — MRS. SHERRI ANN MICONE APRN

Table of content: MICHAEL L LAROCCO LCSW (NPI 1720319916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770869737 NPI number — MRS. SHERRI ANN MICONE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICONE
Provider First Name:
SHERRI
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPIVA
Provider Other First Name:
SHERRI
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1770869737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 MILL ST STE 306
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89502-1195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-455-0110
Provider Business Mailing Address Fax Number:
775-455-0375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 MILL ST STE 306
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89502-1195
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-455-0110
Provider Business Practice Location Address Fax Number:
775-455-0375
Provider Enumeration Date:
10/21/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN001340 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RN52579 . This is a "RN LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 12367907 . This is a "CAQH" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".