Provider Demographics
NPI:1932465531
Name:JOHN, CHERYL LYDIA (RN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYDIA
Last Name:JOHN
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 1:330 SMITH STREET
Mailing Address - Street 2:109B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:718-330-9322
Mailing Address - Fax:
Practice Address - Street 1:330 SMITH ST
Practice Address - Street 2:109B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4604
Practice Address - Country:US
Practice Address - Phone:718-330-9322
Practice Address - Fax:718-596-2969
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY569308-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse