Provider Demographics
NPI:1740740653
Name:ROSEN, CHERISE C (APRN, PHD)
Entity Type:Individual
Prefix:DR
First Name:CHERISE
Middle Name:C
Last Name:ROSEN
Suffix:
Gender:F
Credentials:APRN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FRANK LLOYD WRIGHT LN
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2616
Mailing Address - Country:US
Mailing Address - Phone:773-416-4654
Mailing Address - Fax:
Practice Address - Street 1:110 FRANK LLOYD WRIGHT LN
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2616
Practice Address - Country:US
Practice Address - Phone:773-416-4654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.225956163WP0808X
IL209.010702363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty