Healthcare Provider Details

I. General information

NPI: 1730197278
Provider Name (Legal Business Name): CHERYL HENRY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 E MILLER RD
FAIRVIEW MI
48621-8731
US

IV. Provider business mailing address

1910 E MILLER RD
FAIRVIEW MI
48621-8731
US

V. Phone/Fax

Practice location:
  • Phone: 989-848-5644
  • Fax: 989-848-7411
Mailing address:
  • Phone: 989-848-5644
  • Fax: 989-848-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704230124
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: