Healthcare Provider Details

I. General information

NPI: 1669643995
Provider Name (Legal Business Name): CHERYL ANN WHIPP C.R.N.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 E HIGH ST
SPRINGFIELD OH
45505-1412
US

IV. Provider business mailing address

2685 E HIGH ST
SPRINGFIELD OH
45505-1412
US

V. Phone/Fax

Practice location:
  • Phone: 937-323-7377
  • Fax: 937-323-6575
Mailing address:
  • Phone: 937-323-7377
  • Fax: 937-323-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCOA.09107-NA
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: