Provider Demographics
NPI:1700065638
Name:CLINTSMAN, CHERIE ROSE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CHERIE
Middle Name:ROSE
Last Name:CLINTSMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14635 TOWNSHIP HIGHWAY 58
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-9583
Mailing Address - Country:US
Mailing Address - Phone:419-294-3493
Mailing Address - Fax:
Practice Address - Street 1:14635 TOWNSHIP HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-9583
Practice Address - Country:US
Practice Address - Phone:419-294-3493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-28
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH110497164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse