Provider Demographics
NPI:1992029326
Name:CONNERY, CHERYL L (RN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:CONNERY
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 1:555 PRESTIGE CT
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:WI
Mailing Address - Zip Code:53534-9390
Mailing Address - Country:US
Mailing Address - Phone:608-884-2867
Mailing Address - Fax:
Practice Address - Street 1:555 PRESTIGE CT
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:WI
Practice Address - Zip Code:53534-9390
Practice Address - Country:US
Practice Address - Phone:608-884-2867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-14
Last Update Date:2010-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI169037-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse