Provider Demographics
NPI:1386189389
Name:BELL, CHERYL ANN (OFFICE MANAGER)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:BELL
Suffix:
Gender:F
Credentials:OFFICE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MEADOWLARK DR
Mailing Address - Street 2:PO BOX 152
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7798
Mailing Address - Country:US
Mailing Address - Phone:651-245-3991
Mailing Address - Fax:
Practice Address - Street 1:571 LAKERIDGE DR
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-2321
Practice Address - Country:US
Practice Address - Phone:763-202-7722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR180157-0163W00000X
MNR138148-5163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6122056Medicaid