Provider Demographics
NPI:1851683528
Name:OLOFSSON, CHERYL ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:OLOFSSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N WALL STREET
Mailing Address - Street 2:SUITE 510
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901
Mailing Address - Country:US
Mailing Address - Phone:815-932-5725
Mailing Address - Fax:815-932-5872
Practice Address - Street 1:400 N WALL ST
Practice Address - Street 2:SUITE 510
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2940
Practice Address - Country:US
Practice Address - Phone:815-932-5725
Practice Address - Fax:815-932-5872
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041240910163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator