Healthcare Provider Details

I. General information

NPI: 1114259652
Provider Name (Legal Business Name): CHERYL L COLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S MANUFACTURERS ROW
TRENTON TN
38382-3632
US

IV. Provider business mailing address

32 GEORGE TUGGLE RD
TRENTON TN
38382-9573
US

V. Phone/Fax

Practice location:
  • Phone: 731-855-7601
  • Fax: 731-855-7603
Mailing address:
  • Phone: 731-559-4390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0000061131
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: