Provider Demographics
NPI:1689727299
Name:JOHNSON, CHERYL MARIE (CNS FNP-C)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNS FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 TAMARRON LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9373
Mailing Address - Country:US
Mailing Address - Phone:033-601-9523
Mailing Address - Fax:
Practice Address - Street 1:2593 PARK LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3172
Practice Address - Country:US
Practice Address - Phone:303-718-2976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO118657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO$$$$$$$$$Medicare PIN