Provider Demographics
NPI:1861454811
Name:MUSSER, CHERYL SUE (CRNA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:SUE
Last Name:MUSSER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:SUE
Other - Last Name:LEWIS & KUTCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:PO BOX 92
Mailing Address - City:BEECHER CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62414-0092
Mailing Address - Country:US
Mailing Address - Phone:217-821-5291
Mailing Address - Fax:
Practice Address - Street 1:541 VALLEY VIEW DR
Practice Address - Street 2:541 VALLEY VIEW DR
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6138
Practice Address - Country:US
Practice Address - Phone:309-277-1164
Practice Address - Fax:309-277-1164
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001722367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
K07728Medicare ID - Type Unspecified