Provider Demographics
NPI:1588196455
Name:GREEN, CHERYL A (APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:GREEN
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 TECHNOLOGY LN
Mailing Address - Street 2:
Mailing Address - City:COWEN
Mailing Address - State:WV
Mailing Address - Zip Code:26206-3702
Mailing Address - Country:US
Mailing Address - Phone:304-226-3150
Mailing Address - Fax:304-226-3154
Practice Address - Street 1:70 TECHNOLOGY LN
Practice Address - Street 2:
Practice Address - City:COWEN
Practice Address - State:WV
Practice Address - Zip Code:26206-3702
Practice Address - Country:US
Practice Address - Phone:304-226-3150
Practice Address - Fax:304-226-3154
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN45784-NP-C364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health