Healthcare Provider Details

I. General information

NPI: 1205254745
Provider Name (Legal Business Name): MARY CHERRICO RN, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR. E 257 GH/ UNIVERSITY OF IOWA/CPH/PREVENTIVE INTERVENTION CENTER
IOWA CITY IA
52252
US

IV. Provider business mailing address

3100 FALCON DR NE
CEDAR RAPIDS IA
52402-2636
US

V. Phone/Fax

Practice location:
  • Phone: 319-384-5030
  • Fax: 319-384-5045
Mailing address:
  • Phone: 319-393-6538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA-080578
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number080578
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: