Healthcare Provider Details

I. General information

NPI: 1679770283
Provider Name (Legal Business Name): CHERYLE ELAINE BAKEWELL CNP, APRN-BC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4808 MCMAHON BLVD NW
ALBUQUERQUE NM
87114-5010
US

IV. Provider business mailing address

304 ALDABA CIR NE
RIO RANCHO NM
87124-0839
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-9676
  • Fax: 505-277-1363
Mailing address:
  • Phone: 505-259-4702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN438237
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN-70132, CNP01545
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: