MEDICARE: CHERYL G. SCALORA CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	AP111647	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	890001003	OTHER	TX	RR MCR PTAN

General Provider Information

NPI Number	:	1881646131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL G. SCALORA CNM

Provider Business Mailing Address
First Line	:	623 RUSSELL BLVD
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1247
Country	:	US
Telephone Number	:	936-305-5277
Fax Number	:	866-859-9363

Provider Business Practice Location Address
First Line	:	623 RUSSELL BLVD
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1247
Country	:	US
Telephone Number	:	936-305-5277
Fax Number	:	866-859-9363

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	02/27/2024

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