Provider Demographics
NPI:1326584400
Name:VANLEUVEN, CHERYL
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:VANLEUVEN
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 1:2865 NW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3516
Mailing Address - Country:US
Mailing Address - Phone:541-752-0083
Mailing Address - Fax:541-752-9624
Practice Address - Street 1:2865 NW 29TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3516
Practice Address - Country:US
Practice Address - Phone:541-752-0083
Practice Address - Fax:541-752-9624
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285827816Medicare PIN
1164755070Medicare PIN
1194984567Medicare PIN
1619285038Medicare PIN