Provider Demographics
NPI:1699216200
Name:CHINN, CHERRY
Entity Type:Individual
Prefix:
First Name:CHERRY
Middle Name:
Last Name:CHINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 1/2 SW H AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-4841
Mailing Address - Country:US
Mailing Address - Phone:580-514-8619
Mailing Address - Fax:
Practice Address - Street 1:1512 1/2 SW H AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4841
Practice Address - Country:US
Practice Address - Phone:580-514-8619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor