Provider Demographics
NPI:1679610570
Name:ALEXANDER, CHERYL A (LPN)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:A
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30404 BEACHVIEW LN
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-3406
Mailing Address - Country:US
Mailing Address - Phone:262-514-2018
Mailing Address - Fax:
Practice Address - Street 1:30404 BEACHVIEW LN
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-3406
Practice Address - Country:US
Practice Address - Phone:262-514-2018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27964-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39874300Medicaid