Provider Demographics
NPI:1669784286
Name:MEAD, SHERRY A (ARPN)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:A
Last Name:MEAD
Suffix:
Gender:F
Credentials:ARPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 S 24TH ST
Mailing Address - Street 2:STE 230
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1226
Mailing Address - Country:US
Mailing Address - Phone:402-978-5656
Mailing Address - Fax:402-591-5075
Practice Address - Street 1:5017 LEAVENWORTH ST
Practice Address - Street 2:STE 1
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-1438
Practice Address - Country:US
Practice Address - Phone:402-661-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110265363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner