Provider Demographics
NPI:1356650196
Name:MANEY, CHERYL (APN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:MANEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 E LOWRY BLVD
Mailing Address - Street 2:INNOVAGE-ATTN: GAYLE WASHINGTON
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230
Mailing Address - Country:US
Mailing Address - Phone:303-912-7193
Mailing Address - Fax:
Practice Address - Street 1:8405 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2908
Practice Address - Country:US
Practice Address - Phone:720-974-5400
Practice Address - Fax:720-974-4992
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX546701363LF0000X
COAPN.0990577-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicaid
TXP36594OtherUPIN
TXMA086N266OtherMEDICARE ID
TX4298590001OtherDME ID