Provider Demographics
NPI:1417003906
Name:WILEY, CHERYL L (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:L
Last Name:WILEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:L
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007
Mailing Address - Country:US
Mailing Address - Phone:530-365-2545
Mailing Address - Fax:530-365-3871
Practice Address - Street 1:2830 EAST STREET
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007
Practice Address - Country:US
Practice Address - Phone:530-365-2545
Practice Address - Fax:530-365-3871
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM53832HMedicaid
CARHM55382Medicare ID - Type UnspecifiedRURAL HEALTH
CARHM53832HMedicaid