Provider Demographics
NPI:1376596924
Name:HAEFELE, CHERYL M (PA-C)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:M
Last Name:HAEFELE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4213
Mailing Address - Country:US
Mailing Address - Phone:717-262-9700
Mailing Address - Fax:717-264-6522
Practice Address - Street 1:825 5TH AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4213
Practice Address - Country:US
Practice Address - Phone:717-262-9700
Practice Address - Fax:717-264-6522
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052083363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104108Medicare PIN
PAQ50230Medicare UPIN