Healthcare Provider Details

I. General information

NPI: 1821030974
Provider Name (Legal Business Name): CHERYL LYNN KOKKINOS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LA RED HEALTH CENTER 505A WEST MARKET STREET
GEORGETOWN DE
19947-2321
US

IV. Provider business mailing address

LA RED HEALTH CENTER 505A WEST MARKET STREET
GEORGETOWN DE
19947-2321
US

V. Phone/Fax

Practice location:
  • Phone: 302-855-1233
  • Fax: 302-855-1020
Mailing address:
  • Phone: 302-855-1233
  • Fax: 302-855-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: