Provider Demographics
NPI:1609407931
Name:CHILDERS, CHERYL (RN,BSN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 OLD MAIN DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1360
Mailing Address - Country:US
Mailing Address - Phone:304-872-3611
Mailing Address - Fax:
Practice Address - Street 1:400 OLD MAIN DR
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1360
Practice Address - Country:US
Practice Address - Phone:304-872-3611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV74663163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool