Provider Demographics
NPI:1255336640
Name:EKOBENA, SHERRI L (PA)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:L
Last Name:EKOBENA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:L
Other - Last Name:TEN NAPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2535 S DOWNING ST STE 360
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5850
Mailing Address - Country:US
Mailing Address - Phone:303-260-2740
Mailing Address - Fax:303-260-2741
Practice Address - Street 1:2535 S DOWNING ST STE 360
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5850
Practice Address - Country:US
Practice Address - Phone:303-260-2740
Practice Address - Fax:303-260-2741
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004843363AM0700X
WI1554363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41967600Medicaid
P82683Medicare UPIN
WI0716Medicare PIN