Provider Demographics
NPI:1053890293
Name:WILLIS, SHERRI (LVN)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:SHERRI
Other - Middle Name:
Other - Last Name:HERRADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:412 W OLD US HIGHWAY 80 APT C
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75693-2038
Mailing Address - Country:US
Mailing Address - Phone:682-234-6267
Mailing Address - Fax:
Practice Address - Street 1:707 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLADEWATER
Practice Address - State:TX
Practice Address - Zip Code:75647-2207
Practice Address - Country:US
Practice Address - Phone:682-234-6267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189159164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse