Provider Demographics
NPI:1073640058
Name:WILLETT, CHERYL M (RN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:M
Last Name:WILLETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:M
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16253 W 66TH CIR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7591
Mailing Address - Country:US
Mailing Address - Phone:303-421-4086
Mailing Address - Fax:
Practice Address - Street 1:11245 HURON ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2806
Practice Address - Country:US
Practice Address - Phone:303-457-6149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO109027163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
008900OtherKAISER-COMMERCIAL NUMBER