Provider Demographics
NPI:1528561222
Name:WALDRUM, CHERYL JEANENE
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:JEANENE
Last Name:WALDRUM
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 1:2122 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4430
Mailing Address - Country:US
Mailing Address - Phone:931-797-5891
Mailing Address - Fax:
Practice Address - Street 1:1541 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-7617
Practice Address - Country:US
Practice Address - Phone:931-797-5891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider