Provider Demographics
NPI:1124537451
Name:BEVANS, CHERI (RN, LMT)
Entity Type:Individual
Prefix:MRS
First Name:CHERI
Middle Name:
Last Name:BEVANS
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:MISS
Other - First Name:CHERI
Other - Middle Name:
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3529 FLANNERY LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-6107
Mailing Address - Country:US
Mailing Address - Phone:443-850-3532
Mailing Address - Fax:
Practice Address - Street 1:4118 AMOS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3310
Practice Address - Country:US
Practice Address - Phone:443-429-0434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM05787225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist