Provider Demographics
NPI:1841205333
Name:HAIRGROVE, CHERYL (PAC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:HAIRGROVE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PEABODY DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57274-1061
Mailing Address - Country:US
Mailing Address - Phone:605-345-4141
Mailing Address - Fax:605-345-4135
Practice Address - Street 1:101 PEABODY DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:SD
Practice Address - Zip Code:57274-1061
Practice Address - Country:US
Practice Address - Phone:605-345-4141
Practice Address - Fax:605-345-4135
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR016878363A00000X
SD0565363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00116806Medicare PIN
SDS101647Medicare PIN