Healthcare Provider Details

I. General information

NPI: 1124290937
Provider Name (Legal Business Name): JACLYN MICHELLE CHERRY RN, ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CLAYTON STREET, SUITE 500 PULMONARY ASSOCIATES
WILMINGTON DE
19803
US

IV. Provider business mailing address

203 BROMLEY DR
WILMINGTON DE
19808-1375
US

V. Phone/Fax

Practice location:
  • Phone: 302-656-2296
  • Fax:
Mailing address:
  • Phone: 302-256-0653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN557986
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0030704
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLZ-0000113
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP009771
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: