Provider Demographics
NPI:1649742057
Name:CARRELL, CHERYL W (RN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:W
Last Name:CARRELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462-1298
Mailing Address - Country:US
Mailing Address - Phone:207-723-3393
Mailing Address - Fax:207-723-3018
Practice Address - Street 1:200 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462-1298
Practice Address - Country:US
Practice Address - Phone:207-723-3393
Practice Address - Fax:207-723-3018
Is Sole Proprietor?:No
Enumeration Date:2018-12-24
Last Update Date:2018-12-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MERN24087163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator