Provider Demographics
NPI:1295274132
Name:CHEROLIS, JENNIFER MAE (BSN,RN,CDE,MLDE)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MAE
Last Name:CHEROLIS
Suffix:
Gender:F
Credentials:BSN,RN,CDE,MLDE
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CRASK
Other - Last Name:CHEROLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:830 S LIMESTONE UNIVERSITY HEALTH SERVICES BUILDING
Mailing Address - Street 2:4TH FLOOR, BARNSTABLE BROWN DIABETES CENTER
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-5407
Mailing Address - Fax:859-257-0487
Practice Address - Street 1:2195 HARRODSBURG RD STE 125
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3504
Practice Address - Country:US
Practice Address - Phone:859-323-2232
Practice Address - Fax:859-257-0659
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1064122163W00000X
KY131302163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163W00000XNursing Service ProvidersRegistered Nurse