Healthcare Provider Details

I. General information

NPI: 1285614685
Provider Name (Legal Business Name): ROBERTA GRAY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBERTA CHERRYWELL

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 LUCY DR
HARRISONBURG VA
22801-8036
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-438-1314
  • Fax: 540-438-0797
Mailing address:
  • Phone: 540-438-1314
  • Fax: 540-438-0797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberME00024500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024172520
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number0024172520
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: