Provider Demographics
NPI:1619480027
Name:DAHLSTROEM, CHERYL ANN (RN, BSN, NP-C, A-GNP)
Entity Type:Individual
Prefix:MISS
First Name:CHERYL
Middle Name:ANN
Last Name:DAHLSTROEM
Suffix:
Gender:F
Credentials:RN, BSN, NP-C, A-GNP
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:NANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:1711 27TH ST STE 402
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2669
Practice Address - Country:US
Practice Address - Phone:740-356-3562
Practice Address - Fax:740-355-6938
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV93998363LG0600X
OHAPRN.CNP.023978363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0251073Medicaid