Healthcare Provider Details

I. General information

NPI: 1114400397
Provider Name (Legal Business Name): CHERISE SINDBERG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERISE DECORAH

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6630 COVERED BRIDGE TRL
SUN PRAIRIE WI
53590-3878
US

IV. Provider business mailing address

6630 COVERED BRIDGE TRL
SUN PRAIRIE WI
53590-3878
US

V. Phone/Fax

Practice location:
  • Phone: 608-843-8045
  • Fax:
Mailing address:
  • Phone: 608-843-8045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number195999
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2467240
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number13468
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: