Provider Demographics
NPI:1891113668
Name:PUOPOLO, CHERYL (LPN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:PUOPOLO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4411
Mailing Address - Country:US
Mailing Address - Phone:508-583-9800
Mailing Address - Fax:508-583-9802
Practice Address - Street 1:820 PEARL ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4411
Practice Address - Country:US
Practice Address - Phone:508-583-9800
Practice Address - Fax:508-583-9802
Is Sole Proprietor?:No
Enumeration Date:2014-03-30
Last Update Date:2014-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN88009164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse