Provider Demographics
NPI:1710221528
Name:ROBERTS, CHERYL LYNN (RN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 670
Mailing Address - Street 2:
Mailing Address - City:OURAY
Mailing Address - State:CO
Mailing Address - Zip Code:81427-0670
Mailing Address - Country:US
Mailing Address - Phone:970-325-4670
Mailing Address - Fax:970-325-7413
Practice Address - Street 1:302 2ND STREET
Practice Address - Street 2:
Practice Address - City:OURAY
Practice Address - State:CO
Practice Address - Zip Code:81427-0670
Practice Address - Country:US
Practice Address - Phone:970-325-4670
Practice Address - Fax:970-325-7413
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0060839163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC30686Medicare PIN