Provider Demographics
NPI:1497188775
Name:WILSON, CHERI MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:CHERI
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:CHERI
Other - Middle Name:MARIE
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2795 ELIZABETH AVE
Mailing Address - Street 2:#41
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-8764
Mailing Address - Country:US
Mailing Address - Phone:719-221-8963
Mailing Address - Fax:
Practice Address - Street 1:2795 ELIZABETH AVE
Practice Address - Street 2:#41
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-8764
Practice Address - Country:US
Practice Address - Phone:719-221-8963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPN0048408164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse