Healthcare Provider Details

I. General information

NPI: 1548605595
Provider Name (Legal Business Name): CHERIE GHOLSTON CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8921 EDNA ST
SAINT LOUIS MO
63147-1713
US

IV. Provider business mailing address

8921 EDNA ST
SAINT LOUIS MO
63147-1713
US

V. Phone/Fax

Practice location:
  • Phone: 314-482-4641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number139161
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: