Provider Demographics
NPI:1174749501
Name:LANDSEM WALFORD, SHERRIE R (MT)
Entity type:Individual
Prefix:MS
First Name:SHERRIE
Middle Name:R
Last Name:LANDSEM WALFORD
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-6002
Mailing Address - Country:US
Mailing Address - Phone:701-662-0213
Mailing Address - Fax:
Practice Address - Street 1:3883 74TH AVENUE NE
Practice Address - Street 2:BOX 309
Practice Address - City:FORT TOTTEN
Practice Address - State:ND
Practice Address - Zip Code:58335-0309
Practice Address - Country:US
Practice Address - Phone:701-766-1600
Practice Address - Fax:701-766-1640
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician