Provider Demographics
NPI:1124595335
Name:STROTHER, CHERYLE DIANA
Entity Type:Individual
Prefix:
First Name:CHERYLE
Middle Name:DIANA
Last Name:STROTHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 N PLUM ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-1817
Mailing Address - Country:US
Mailing Address - Phone:815-844-4631
Mailing Address - Fax:815-844-1942
Practice Address - Street 1:402 N PLUM ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-1817
Practice Address - Country:US
Practice Address - Phone:815-844-4631
Practice Address - Fax:815-844-1942
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016968363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily