Healthcare Provider Details

I. General information

NPI: 1851683528
Provider Name (Legal Business Name): CHERYL ANN OLOFSSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N WALL ST SUITE 510
KANKAKEE IL
60901-2940
US

IV. Provider business mailing address

400 N WALL STREET SUITE 510
KANKAKEE IL
60901
US

V. Phone/Fax

Practice location:
  • Phone: 815-932-5725
  • Fax: 815-932-5872
Mailing address:
  • Phone: 815-932-5725
  • Fax: 815-932-5872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number041240910
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: