Provider Demographics
NPI:1245041771
Name:CANADA, CHERYL
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:CANADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 342
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:IL
Mailing Address - Zip Code:61516-0342
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 E STATE ROUTE 116
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:IL
Practice Address - Zip Code:61516-9697
Practice Address - Country:US
Practice Address - Phone:402-718-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant