Provider Demographics
NPI:1851640825
Name:CARMACK, CHERYL A
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:CARMACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:A
Other - Last Name:NAFZIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1231 KLEEMANN DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-2633
Mailing Address - Country:US
Mailing Address - Phone:217-935-5022
Mailing Address - Fax:217-935-9592
Practice Address - Street 1:1231 KLEEMANN DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-2633
Practice Address - Country:US
Practice Address - Phone:217-935-5022
Practice Address - Fax:217-935-9592
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-009693363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner