Healthcare Provider Details

I. General information

NPI: 1356653307
Provider Name (Legal Business Name): JUSTIN PAUL CHERREY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 04/06/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 MDG UNIT 3215 RAMSTEIN AB
APO AE
09094
US

IV. Provider business mailing address

PSC 2 BOX 15219
APO AE
09012-0153
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-2168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number71344
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN-71344
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: