Healthcare Provider Details

I. General information

NPI: 1164448601
Provider Name (Legal Business Name): CHERYL A HENDERSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DR MHMC-PEDIATRICS
CLEVELAND OH
44109-1900
US

IV. Provider business mailing address

2500 METROHEALTH DR MHMC-PEDIATRICS
CLEVELAND OH
44109-1900
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-5909
  • Fax:
Mailing address:
  • Phone: 216-778-5909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP00664
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: