Provider Demographics
NPI:1821348129
Name:HARRIS, CHERYL PATRICE (APN FNP)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:PATRICE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:APN FNP
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:PATRICE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1155 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-0701
Mailing Address - Country:US
Mailing Address - Phone:815-741-5023
Mailing Address - Fax:
Practice Address - Street 1:1155 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-0701
Practice Address - Country:US
Practice Address - Phone:815-741-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily