Healthcare Provider Details

I. General information

NPI: 1992170302
Provider Name (Legal Business Name): CHERYL WHIPPLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHERYL ANN MAKARA RN

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SILVER STREET
MIDDLETOWN CT
06457-7023
US

IV. Provider business mailing address

PO BOX 351 1000 SILVER ST.
MIDDLETOWN CT
06457-7023
US

V. Phone/Fax

Practice location:
  • Phone: 860-262-6473
  • Fax: 860-262-5638
Mailing address:
  • Phone: 860-262-6473
  • Fax: 860-262-5638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number005033
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberE52483
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: