Healthcare Provider Details

I. General information

NPI: 1669735312
Provider Name (Legal Business Name): CHERI CUTLIP AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 10/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6674 TIPPECANOE RD STE 1
CANFIELD OH
44406-9149
US

IV. Provider business mailing address

6674 TIPPECANOE RD STE 1
CANFIELD OH
44406-9149
US

V. Phone/Fax

Practice location:
  • Phone: 330-533-8490
  • Fax:
Mailing address:
  • Phone: 330-533-8490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN239947
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.020647
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN.239947
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: