Healthcare Provider Details

I. General information

NPI: 1538804604
Provider Name (Legal Business Name): CHERYL YVONNE UNDERWOOD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE AVE NE
ALBUQUERQUE NM
87106-2058
US

IV. Provider business mailing address

166 SANDIA VIEW RD
CORRALES NM
87048-8716
US

V. Phone/Fax

Practice location:
  • Phone: 928-729-8000
  • Fax: 505-272-9843
Mailing address:
  • Phone: 727-510-7934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number78994
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number78994
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN3384592
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: