Healthcare Provider Details

I. General information

NPI: 1528973906
Provider Name (Legal Business Name): CHERYL LYN ELLEDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL LYN DOVE

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N CENTRAL AVE
SUPERIOR NE
68978-1736
US

IV. Provider business mailing address

207 N CENTRAL AVE
SUPERIOR NE
68978-1736
US

V. Phone/Fax

Practice location:
  • Phone: 402-879-3235
  • Fax: 402-879-3239
Mailing address:
  • Phone: 402-879-3235
  • Fax: 402-879-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: