Healthcare Provider Details

I. General information

NPI: 1750449310
Provider Name (Legal Business Name): MRS. CHERYL LYNETTE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PILLARS 1023 BURLINGTON
WESTERN SPRINGS IL
60558
US

IV. Provider business mailing address

42 WASHINGTON
LA GRANGE IL
60525
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-0826
  • Fax: 708-354-0867
Mailing address:
  • Phone: 708-482-4038
  • Fax: 708-354-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: