Provider Demographics
NPI:1467667709
Name:DURHAM, CHERYL LYNN
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:DURHAM
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 1:4827 HUMMINGBIRD CT. N
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5618
Mailing Address - Country:US
Mailing Address - Phone:614-438-9836
Mailing Address - Fax:
Practice Address - Street 1:1631 GRANITEWAY LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6511
Practice Address - Country:US
Practice Address - Phone:614-846-5178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2479358Medicaid