Provider Demographics
NPI:1851481139
Name:GARD, CHERYL ANN (CNM, CRNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:GARD
Suffix:
Gender:F
Credentials:CNM, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 EMBASSY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2385
Mailing Address - Country:US
Mailing Address - Phone:717-509-5090
Mailing Address - Fax:717-509-5078
Practice Address - Street 1:2128 EMBASSY DR
Practice Address - Street 2:SUITE B
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2385
Practice Address - Country:US
Practice Address - Phone:717-509-5090
Practice Address - Fax:717-509-5078
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008543L367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS52478Medicare UPIN
PA0079S4S3CMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #