Provider Demographics
NPI:1831264910
Name:GOLDEN, CHERI A
Entity type:Individual
Prefix:MS
First Name:CHERI
Middle Name:A
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 W CRESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-5535
Mailing Address - Country:US
Mailing Address - Phone:907-841-0169
Mailing Address - Fax:907-841-0169
Practice Address - Street 1:440 W BENSON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3860
Practice Address - Country:US
Practice Address - Phone:907-334-3050
Practice Address - Fax:907-334-3050
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM5367Medicaid