Provider Demographics
NPI:1730437575
Name:KWANISAI, SHERIAN K (RNP)
Entity type:Individual
Prefix:MRS
First Name:SHERIAN
Middle Name:K
Last Name:KWANISAI
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 W. MARKHAM SLOT 21
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3867
Mailing Address - Country:US
Mailing Address - Phone:501-661-2796
Mailing Address - Fax:501-661-2545
Practice Address - Street 1:4815 W. MARKHAM SLOT 21
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3867
Practice Address - Country:US
Practice Address - Phone:501-661-2796
Practice Address - Fax:501-661-2545
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP01265363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner