Provider Demographics
NPI:1801088372
Name:WILSON, SHERRY LEE (PA-C)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:LEE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-340-3911
Mailing Address - Fax:
Practice Address - Street 1:40075 BOB HOPE DR STE A
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3945
Practice Address - Country:US
Practice Address - Phone:760-341-3688
Practice Address - Fax:760-341-8992
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA58178363AM0700X
OH50-001339363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical