Healthcare Provider Details

I. General information

NPI: 1023435260
Provider Name (Legal Business Name): CHERYLENE AQUINO PRICKETT RN, MN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2837 OLD BELLEVILLE RD
SAINT MATTHEWS SC
29135-9010
US

IV. Provider business mailing address

182 DOODLE HILL RD
SAINT MATTHEWS SC
29135-8202
US

V. Phone/Fax

Practice location:
  • Phone: 803-874-2037
  • Fax:
Mailing address:
  • Phone: 803-874-3630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number49762
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: