Provider Demographics
NPI:1770869737
Name:MICONE, SHERRI ANN (APRN)
Entity type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:ANN
Last Name:MICONE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:ANN
Other - Last Name:SPIVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:560 MILL ST STE 306
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1195
Mailing Address - Country:US
Mailing Address - Phone:775-455-0110
Mailing Address - Fax:775-455-0375
Practice Address - Street 1:560 MILL ST STE 306
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1195
Practice Address - Country:US
Practice Address - Phone:775-455-0110
Practice Address - Fax:775-455-0375
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRN52579OtherRN LICENSE
NV12367907OtherCAQH