Provider Demographics
NPI:1801266697
Name:SAMUELS, CHERESHA LYNN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:CHERESHA
Middle Name:LYNN
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CHERESHA
Other - Middle Name:LYNN
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:145 NORTH 6TH STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601
Mailing Address - Country:US
Mailing Address - Phone:610-378-2000
Mailing Address - Fax:
Practice Address - Street 1:145 N 6TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3096
Practice Address - Country:US
Practice Address - Phone:610-378-2440
Practice Address - Fax:610-378-2441
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015067363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily