Provider Demographics
NPI:1205915816
Name:DAVIDSON, CHERYL DENE (CRNFA FNP-C)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:DENE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:CRNFA FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18341 SE CALEB LN
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97089-6019
Mailing Address - Country:US
Mailing Address - Phone:503-667-4873
Mailing Address - Fax:503-667-6782
Practice Address - Street 1:18341 SE CALEB LN
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:OR
Practice Address - Zip Code:97009-9619
Practice Address - Country:US
Practice Address - Phone:503-667-4873
Practice Address - Fax:503-667-6782
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650017NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORQ75347Medicare UPIN
ORR138736Medicare PIN