Provider Demographics
NPI:1508916875
Name:WILLIN, CHERYLL L (CNP)
Entity Type:Individual
Prefix:
First Name:CHERYLL
Middle Name:L
Last Name:WILLIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490A W ZIA RD
Mailing Address - Street 2:NEW MEXICO CANCER CARE ASSOCIATES
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6996
Mailing Address - Country:US
Mailing Address - Phone:505-913-8900
Mailing Address - Fax:505-913-8923
Practice Address - Street 1:490A W ZIA RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6996
Practice Address - Country:US
Practice Address - Phone:505-913-8900
Practice Address - Fax:505-913-6441
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13235363L00000X
NMCNP-01513363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM62820532Medicaid
NM62820532Medicaid