Provider Demographics
NPI:1659468114
Name:LONABAUGH, CHERYL ANN (NP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:LONABAUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:LONABAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1113 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-4128
Mailing Address - Country:US
Mailing Address - Phone:843-248-6269
Mailing Address - Fax:
Practice Address - Street 1:1113 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-4128
Practice Address - Country:US
Practice Address - Phone:843-348-6269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019279363L00000X
DEL1-0028446163W00000X
SC23063363LF0000X
DELG-0000351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD556304600Medicaid
014744D48Medicare ID - Type Unspecified
MD556304600Medicaid