Provider Demographics
NPI:1255103784
Name:GUAJARDO, CHERYL MARIE
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:MARIE
Last Name:GUAJARDO
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 1:1657 S GETTY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5872
Mailing Address - Country:US
Mailing Address - Phone:231-375-5133
Mailing Address - Fax:231-375-8147
Practice Address - Street 1:1657 S GETTY ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5872
Practice Address - Country:US
Practice Address - Phone:231-375-5133
Practice Address - Fax:231-375-8147
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health