Provider Demographics
NPI:1720665581
Name:CORNWELL-ESHETE, CHERI (MD)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:
Last Name:CORNWELL-ESHETE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9710 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-2232
Mailing Address - Country:US
Mailing Address - Phone:360-653-1742
Mailing Address - Fax:360-657-3057
Practice Address - Street 1:4111 ALDERWOOD MALL BLVD
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6765
Practice Address - Country:US
Practice Address - Phone:425-977-2560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program