Provider Demographics
NPI:1740247352
Name:SMITH, CHERYL L (RN, FNP)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MEEKER ST
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-1920
Mailing Address - Country:US
Mailing Address - Phone:970-874-5777
Mailing Address - Fax:970-874-1631
Practice Address - Street 1:555 MEEKER ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-1920
Practice Address - Country:US
Practice Address - Phone:970-874-5777
Practice Address - Fax:970-874-1631
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO98432363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07984321Medicaid
CO07984321Medicaid
S93668Medicare UPIN