Provider Demographics
NPI:1881864858
Name:TREVINO CORNELL, CHERIE
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:
Last Name:TREVINO CORNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3620
Mailing Address - Country:US
Mailing Address - Phone:803-202-0202
Mailing Address - Fax:803-202-0201
Practice Address - Street 1:420 WEST AVE
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3620
Practice Address - Country:US
Practice Address - Phone:803-202-0202
Practice Address - Fax:803-202-0201
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2202174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist