Provider Demographics
NPI:1710176821
Name:CARNEY, CHERYL KAY (CNM)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:KAY
Last Name:CARNEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 COLE ST
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3504
Mailing Address - Country:US
Mailing Address - Phone:360-802-5760
Mailing Address - Fax:360-802-5799
Practice Address - Street 1:1818 COLE ST
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3504
Practice Address - Country:US
Practice Address - Phone:360-802-5760
Practice Address - Fax:360-802-5799
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAPO248367A00000X
WAAP60483980367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8936248Medicare PIN
WAG8936249Medicare PIN