Provider Demographics
NPI:1760553507
Name:MCNULTY, CHERYL ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:MCNULTY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:WISE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:264 STAR MAGNOLIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560
Mailing Address - Country:US
Mailing Address - Phone:919-468-1997
Mailing Address - Fax:
Practice Address - Street 1:3100 DURALEIGH RD
Practice Address - Street 2:E BROOKS WILKINS FAMILY MEDICINE PA
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8104
Practice Address - Country:US
Practice Address - Phone:919-571-6465
Practice Address - Fax:919-571-6455
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229186164W00000X
NC046337164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse