Provider Demographics
NPI:1033477526
Name:WYATT, CHERI LYNNE (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:CHERI
Middle Name:LYNNE
Last Name:WYATT
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 S BUTLER LN
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64056-3056
Mailing Address - Country:US
Mailing Address - Phone:816-665-5398
Mailing Address - Fax:
Practice Address - Street 1:1114 S BUTLER LN
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64056-3056
Practice Address - Country:US
Practice Address - Phone:816-665-5398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005031816163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant