Provider Demographics
NPI:1871903807
Name:JARVIS, CHERYL (NP)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:JARVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:9055 SPRINGBROOK DR NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5841
Mailing Address - Country:US
Mailing Address - Phone:763-780-9155
Mailing Address - Fax:763-236-1066
Practice Address - Street 1:9055 SPRINGBROOK DR NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5841
Practice Address - Country:US
Practice Address - Phone:763-780-9155
Practice Address - Fax:763-236-1066
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR158368-1363L00000X
MN1441363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner