Provider Demographics
NPI:1881322600
Name:STALLO, CHERYL ANN (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:STALLO
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 E BROADWAY STE 101
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8018
Mailing Address - Country:US
Mailing Address - Phone:573-815-3612
Mailing Address - Fax:573-815-2985
Practice Address - Street 1:1701 E BROADWAY STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8018
Practice Address - Country:US
Practice Address - Phone:573-815-3612
Practice Address - Fax:573-815-2985
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020017998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty