Provider Demographics
NPI:1487287173
Name:WALL, SHERRY (CASE MANG/SERV FACIL)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:WALL
Suffix:
Gender:F
Credentials:CASE MANG/SERV FACIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:FREEMAN
Mailing Address - State:VA
Mailing Address - Zip Code:23856-0061
Mailing Address - Country:US
Mailing Address - Phone:434-532-1374
Mailing Address - Fax:434-465-6643
Practice Address - Street 1:1569 GLENDALE MILL RD
Practice Address - Street 2:
Practice Address - City:FREEMAN
Practice Address - State:VA
Practice Address - Zip Code:23856-2447
Practice Address - Country:US
Practice Address - Phone:434-532-1374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty