Healthcare Provider Details

I. General information

NPI: 1740856855
Provider Name (Legal Business Name): CHERRA WHEELER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2021
Last Update Date: 05/29/2021
Certification Date: 05/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALD HILL RD
WARWICK RI
02886-1617
US

IV. Provider business mailing address

169 ROUTE 169
WOODSTOCK CT
06281-3321
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-8100
  • Fax:
Mailing address:
  • Phone: 401-935-6731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN02678
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: