Healthcare Provider Details

I. General information

NPI: 1366039273
Provider Name (Legal Business Name): LYNN MONIQUE CHERRY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYNN M MCKINNEY RN

II. Dates (important events)

Enumeration Date: 12/26/2020
Last Update Date: 12/26/2020
Certification Date: 12/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30997 PENDLETON APT 241
NEW HUDSON MI
48165-9459
US

IV. Provider business mailing address

30997 PENDLETON APT 241
NEW HUDSON MI
48165-9459
US

V. Phone/Fax

Practice location:
  • Phone: 248-505-8649
  • Fax:
Mailing address:
  • Phone: 248-505-8649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number4704182738
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704182738
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: