Provider Demographics
NPI:1548693674
Name:MCNUTT, SHERRIE LYNN (ANP-BC)
Entity type:Individual
Prefix:
First Name:SHERRIE
Middle Name:LYNN
Last Name:MCNUTT
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 W OUTER DR
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1309
Mailing Address - Country:US
Mailing Address - Phone:313-592-5216
Mailing Address - Fax:313-592-5012
Practice Address - Street 1:13400 W OUTER DR
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1309
Practice Address - Country:US
Practice Address - Phone:313-592-5216
Practice Address - Fax:313-592-5012
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704215242363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health