Provider Demographics
NPI:1861560260
Name:SMITH, SHERRY ANN JR (RN)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:ANN
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:DR
Other - First Name:CHANDER
Other - Middle Name:M
Other - Last Name:ARORA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3443 COUNTY ROAD 20
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-9366
Mailing Address - Country:US
Mailing Address - Phone:419-946-1798
Mailing Address - Fax:419-946-1798
Practice Address - Street 1:362 W HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1004
Practice Address - Country:US
Practice Address - Phone:419-688-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 162265163WH0200X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Not Answered163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2102138Medicaid