Provider Demographics
NPI:1356010599
Name:HANSTEDT, CHERYL (RN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:HANSTEDT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4880 COUNTY ROAD 134
Mailing Address - Street 2:
Mailing Address - City:HESPERUS
Mailing Address - State:CO
Mailing Address - Zip Code:81326-9573
Mailing Address - Country:US
Mailing Address - Phone:970-759-1840
Mailing Address - Fax:
Practice Address - Street 1:3401 E 30TH ST STE 4
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-8805
Practice Address - Country:US
Practice Address - Phone:970-599-8609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN.0096683163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORN.0099683Medicaid