MEDICARE: CHERYL VETTER

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	043.107111	IL

General Provider Information

NPI Number	:	1649897547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL VETTER

Provider Business Mailing Address
First Line	:	816 E 47TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-1602
Country	:	US
Telephone Number	:	815-295-7521
Fax Number	:

Provider Business Practice Location Address
First Line	:	1034 S BRENTWOOD BLVD STE 1540
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1229
Country	:	US
Telephone Number	:	815-295-7521
Fax Number	:

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

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	07/07/2020

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