Provider Demographics
NPI:1205964665
Name:SODERLUND, CHERYL (ANP-BC, GNP-BC, CDE)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:SODERLUND
Suffix:
Gender:F
Credentials:ANP-BC, GNP-BC, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WALNUT ST STE 360
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2111
Mailing Address - Country:US
Mailing Address - Phone:781-898-7301
Mailing Address - Fax:781-898-7302
Practice Address - Street 1:65 WALNUT ST STE 360
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2111
Practice Address - Country:US
Practice Address - Phone:781-898-7301
Practice Address - Fax:781-898-7302
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226857363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care