MEDICARE: CHERYL FOX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	4703040115	MI

General Provider Information

NPI Number	:	1336639376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL FOX

Provider Business Mailing Address
First Line	:	9016 SHORTER LAKE RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-8401
Country	:	US
Telephone Number	:	231-409-8218
Fax Number	:

Provider Business Practice Location Address
First Line	:	9016 SHORTER LAKE RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-8401
Country	:	US
Telephone Number	:	231-409-8218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2018
Last Update Date	:	05/15/2018

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Directions to “ CHERYL FOX ” Practice Location

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