Provider Demographics
NPI:1629172788
Name:RINELL, CHERYL K (CNM LNM)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:K
Last Name:RINELL
Suffix:
Gender:F
Credentials:CNM LNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 CHESHIRE RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492
Mailing Address - Country:US
Mailing Address - Phone:203-949-9454
Mailing Address - Fax:
Practice Address - Street 1:850 N MAIN STREET EXT BLDG 2
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2400
Practice Address - Country:US
Practice Address - Phone:203-694-4349
Practice Address - Fax:833-694-4349
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTL-60375163WL0100X
CT000052367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
183841OtherPREFERRED ONE WELLCARE
520001OtherCT CARE
400000052CT01OtherANTHEM BCBS
CT004235736Medicaid
P523095OtherOXFORD
183841OtherPREFERRED ONE WELLCARE