Healthcare Provider Details

I. General information

NPI: 1225780661
Provider Name (Legal Business Name): CHERYL ANN MEYER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHERYL ANN JAEGER

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6750 E BAYWOOD AVE STE 301
MESA AZ
85206-1749
US

IV. Provider business mailing address

6750 E BAYWOOD AVE STE 301
MESA AZ
85206-1749
US

V. Phone/Fax

Practice location:
  • Phone: 616-340-5055
  • Fax: 480-461-4243
Mailing address:
  • Phone: 616-340-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number283421
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704321855
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: