Provider Demographics
NPI:1437651064
Name:CHERNYSH, INESSA (DO)
Entity Type:Individual
Prefix:MRS
First Name:INESSA
Middle Name:
Last Name:CHERNYSH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:MC LEANSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62859-1213
Mailing Address - Country:US
Mailing Address - Phone:618-643-2988
Mailing Address - Fax:618-643-3018
Practice Address - Street 1:611 S MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:MC LEANSBORO
Practice Address - State:IL
Practice Address - Zip Code:62859-1213
Practice Address - Country:US
Practice Address - Phone:618-643-2988
Practice Address - Fax:618-643-3018
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036158525207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine