Provider Demographics
NPI:1225121619
Name:BRAY, CHERYL L (FNP)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:L
Last Name:BRAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 WILLIAM LN
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2434
Mailing Address - Country:US
Mailing Address - Phone:618-235-7030
Mailing Address - Fax:
Practice Address - Street 1:2811 HOMER M ADAMS PKWY
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-4856
Practice Address - Country:US
Practice Address - Phone:618-465-8989
Practice Address - Fax:618-465-8988
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily