Provider Demographics
NPI:1528250826
Name:NELSON, SHERRY D (PA-C)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:D
Last Name:NELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:HOSPITAL ROAD
Mailing Address - City:SAINT MARYS
Mailing Address - State:AK
Mailing Address - Zip Code:99658-0310
Mailing Address - Country:US
Mailing Address - Phone:907-328-9256
Mailing Address - Fax:907-438-3529
Practice Address - Street 1:HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:AK
Practice Address - Zip Code:99658-0310
Practice Address - Country:US
Practice Address - Phone:907-328-9256
Practice Address - Fax:907-438-3529
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK477363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKP55374Medicare UPIN
AK8EZ89DMedicare PIN