Provider Demographics
NPI:1417544289
Name:REVEAL, CHERIE
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:
Last Name:REVEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:OH
Mailing Address - Zip Code:43845-1408
Mailing Address - Country:US
Mailing Address - Phone:740-610-8966
Mailing Address - Fax:
Practice Address - Street 1:612 E 4TH ST
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:OH
Practice Address - Zip Code:43845-1408
Practice Address - Country:US
Practice Address - Phone:740-610-8966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
No253Z00000XAgenciesIn Home Supportive Care