Healthcare Provider Details

I. General information

NPI: 1063626935
Provider Name (Legal Business Name): CHERYL LYNN RAWE RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 AMY CT
DAYTON OH
45415-2101
US

IV. Provider business mailing address

414 AMY CT
DAYTON OH
45415-2101
US

V. Phone/Fax

Practice location:
  • Phone: 937-890-8405
  • Fax:
Mailing address:
  • Phone: 937-890-8405
  • Fax: 937-208-5028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number216613
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: