Provider Demographics
NPI:1548747264
Name:HARRIS, CHERYL LYNN
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:HARRIS
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 1:1416 E. 29TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205
Mailing Address - Country:US
Mailing Address - Phone:720-231-3526
Mailing Address - Fax:303-770-2989
Practice Address - Street 1:1416 E. 29TH AVENUE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-8020
Practice Address - Country:US
Practice Address - Phone:720-231-3526
Practice Address - Fax:303-770-2989
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1211171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
64-0952838OtherOTHER