Provider Demographics
NPI:1013290089
Name:SMITH, CHERYL (RN (BSN AND MSHEP);)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN (BSN AND MSHEP);
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 J YORK RD
Mailing Address - Street 2:#383
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5165
Mailing Address - Country:US
Mailing Address - Phone:301-938-8539
Mailing Address - Fax:410-866-2507
Practice Address - Street 1:01 HOME OFFICE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:301-938-8539
Practice Address - Fax:410-866-2507
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2017-03-23
Deactivation Date:2013-10-04
Deactivation Code:
Reactivation Date:2017-03-09
Provider Licenses
StateLicense IDTaxonomies
MDR165812163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse