Provider Demographics
NPI:1922277862
Name:WILLARD, CHERI LYN (RN)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:LYN
Last Name:WILLARD
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:PO BOX 2130
Mailing Address - Street 2:624 TWIN RIDGE AVE
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82931-2130
Mailing Address - Country:US
Mailing Address - Phone:307-789-8969
Mailing Address - Fax:307-789-8907
Practice Address - Street 1:624 TWIN RIDGE AVE
Practice Address - Street 2:624 TWIN RIDGE AVE
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5108
Practice Address - Country:US
Practice Address - Phone:307-789-8969
Practice Address - Fax:307-789-8907
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY17709163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse