Provider Demographics
NPI:1548275357
Name:GREGORY, SHERRIE M (NP)
Entity type:Individual
Prefix:
First Name:SHERRIE
Middle Name:M
Last Name:GREGORY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4127
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-0127
Mailing Address - Country:US
Mailing Address - Phone:540-981-9394
Mailing Address - Fax:540-344-7154
Practice Address - Street 1:3390 COLONIAL AVE
Practice Address - Street 2:#2
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3740
Practice Address - Country:US
Practice Address - Phone:540-772-1006
Practice Address - Fax:540-772-1086
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0017138633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q72694Medicare UPIN