Provider Demographics
NPI:1811518962
Name:THEARD-CHERY, OLGUINE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:OLGUINE
Middle Name:
Last Name:THEARD-CHERY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22555-0586
Mailing Address - Country:US
Mailing Address - Phone:561-577-7699
Mailing Address - Fax:
Practice Address - Street 1:9 SHORT BRANCH RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-4635
Practice Address - Country:US
Practice Address - Phone:561-577-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily