Provider Demographics
NPI:1841946274
Name:ROUX, CHERYL L (APRN, FNP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:ROUX
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-1852
Mailing Address - Country:US
Mailing Address - Phone:262-473-0400
Mailing Address - Fax:262-473-0408
Practice Address - Street 1:507 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1852
Practice Address - Country:US
Practice Address - Phone:262-473-0400
Practice Address - Fax:262-473-0408
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171616-30163W00000X
WI11771-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse