Provider Demographics
NPI:1922823459
Name:MOORE, CHERISH A (RN)
Entity type:Individual
Prefix:
First Name:CHERISH
Middle Name:A
Last Name:MOORE
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 1:4 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:NY
Mailing Address - Zip Code:12972-4544
Mailing Address - Country:US
Mailing Address - Phone:518-572-3856
Mailing Address - Fax:
Practice Address - Street 1:4 RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:NY
Practice Address - Zip Code:12972-4544
Practice Address - Country:US
Practice Address - Phone:518-572-3856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY816236-01163WG0000X, 163W00000X, 163WC1500X
NY81623601163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health