Healthcare Provider Details

I. General information

NPI: 1720191364
Provider Name (Legal Business Name): CHERYL LEE IZEN APRN,PC,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 DERBY ST
SALEM MA
01970-5132
US

IV. Provider business mailing address

214 DERBY ST
SALEM MA
01970-5132
US

V. Phone/Fax

Practice location:
  • Phone: 978-745-5505
  • Fax:
Mailing address:
  • Phone: 978-745-5505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number135310
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: