Provider Demographics
NPI:1366039273
Name:CHERRY, LYNN MONIQUE (RN)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MONIQUE
Last Name:CHERRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:M
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:30997 PENDLETON APT 241
Mailing Address - Street 2:
Mailing Address - City:NEW HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:48165-9459
Mailing Address - Country:US
Mailing Address - Phone:248-505-8649
Mailing Address - Fax:
Practice Address - Street 1:30997 PENDLETON APT 241
Practice Address - Street 2:
Practice Address - City:NEW HUDSON
Practice Address - State:MI
Practice Address - Zip Code:48165-9459
Practice Address - Country:US
Practice Address - Phone:248-505-8649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704182738163WC1600X, 163W00000X
171M00000X, 251B00000X, 251E00000X, 251J00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)