Provider Demographics
NPI:1376654160
Name:MCCREARY, CHERYL A (CNP)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:A
Last Name:MCCREARY
Suffix:
Gender:F
Credentials:CNP
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Mailing Address - Street 1:5700 BOTTINEAU BLVD #210
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429
Mailing Address - Country:US
Mailing Address - Phone:763-587-7000
Mailing Address - Fax:763-587-7015
Practice Address - Street 1:9825 HOSPITAL DR #205
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:763-587-7000
Practice Address - Fax:763-587-7015
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR103346-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN040317200Medicaid