Healthcare Provider Details

I. General information

NPI: 1134126584
Provider Name (Legal Business Name): CHERYL SPANGLER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4324 GLADES PIKE
SOMERSET PA
15501-1143
US

IV. Provider business mailing address

1086 FRANKLIN ST
JOHNSTOWN PA
15905-4305
US

V. Phone/Fax

Practice location:
  • Phone: 814-445-4585
  • Fax: 814-443-2642
Mailing address:
  • Phone: 814-534-1555
  • Fax: 814-535-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP007520
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: