Basic Information
Provider Information
NPI: 1003147877
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MEURER
FirstName: SHERRY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1709 MOON ST NE
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871123935
CountryCode: US
TelephoneNumber: 5052710329
FaxNumber: 5052714957
Practice Location
Address1: 1709 MOON ST NE
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 87112
CountryCode: US
TelephoneNumber: 5052710329
FaxNumber: 5052714957
Other Information
ProviderEnumerationDate: 01/19/2010
LastUpdateDate: 05/16/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X  N Behavioral Health & Social Service ProvidersSocial Worker 
171M00000X  Y Other Service ProvidersCase Manager/Care Coordinator 

No ID Information.


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