Healthcare Provider Details

I. General information

NPI: 1467369546
Provider Name (Legal Business Name): INDIGO CHERRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 E MCANDREWS RD
MEDFORD OR
97504-5576
US

IV. Provider business mailing address

2014 DEER POINTE CT
MEDFORD OR
97501-8178
US

V. Phone/Fax

Practice location:
  • Phone: 541-414-4535
  • Fax:
Mailing address:
  • Phone: 916-616-8419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10017461
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: