Healthcare Provider Details

I. General information

NPI: 1205281797
Provider Name (Legal Business Name): CHERYL CORINTHIAN NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

11026 DAVID STONE DR
CHAPEL HILL NC
27517-7415
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-8000
  • Fax:
Mailing address:
  • Phone: 919-612-6292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number230358
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: