1124003538 NPI number — SHERRY HICKS STENEHJEM DPM

Table of content: SHERRY HICKS STENEHJEM DPM (NPI 1124003538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124003538 NPI number — SHERRY HICKS STENEHJEM DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STENEHJEM
Provider First Name:
SHERRY
Provider Middle Name:
HICKS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HICKS
Provider Other First Name:
SHERRY
Provider Other Middle Name:
L
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:
1124003538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 SUMMER STREET
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02038-1914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-528-2525
Provider Business Mailing Address Fax Number:
508-520-8901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 SUMMER STREET
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-528-2525
Provider Business Practice Location Address Fax Number:
508-520-8901
Provider Enumeration Date:
12/08/2005

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: 213E00000X , with the licence number:  2192 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 27-00887 . This is a "EVERCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y71112 . This is a "BC/BS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA14520 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 467403 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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