Healthcare Provider Details

I. General information

NPI: 1649742057
Provider Name (Legal Business Name): CHERYL W CARRELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2018
Last Update Date: 12/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOMERSET ST
MILLINOCKET ME
04462-1298
US

IV. Provider business mailing address

200 SOMERSET ST
MILLINOCKET ME
04462-1298
US

V. Phone/Fax

Practice location:
  • Phone: 207-723-3393
  • Fax: 207-723-3018
Mailing address:
  • Phone: 207-723-3393
  • Fax: 207-723-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN24087
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: