Provider Demographics
NPI:1790068781
Name:MITTRY, CHERYL L (RESPITE CARE)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:L
Last Name:MITTRY
Suffix:
Gender:F
Credentials:RESPITE CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1173 BRIGHTON VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-5226
Mailing Address - Country:US
Mailing Address - Phone:707-789-9609
Mailing Address - Fax:707-789-9609
Practice Address - Street 1:1173 BRIGHTON VIEW CIR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-5226
Practice Address - Country:US
Practice Address - Phone:707-789-9609
Practice Address - Fax:707-789-9609
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide