Provider Demographics
NPI:1164508537
Name:KOVALENKO, CHERI L (CNP)
Entity Type:Individual
Prefix:MS
First Name:CHERI
Middle Name:L
Last Name:KOVALENKO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5816 W KING ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-0675
Mailing Address - Country:US
Mailing Address - Phone:605-361-6055
Mailing Address - Fax:
Practice Address - Street 1:911 E 20TH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1042
Practice Address - Country:US
Practice Address - Phone:605-322-3440
Practice Address - Fax:605-322-3654
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR033474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6825360Medicaid