MEDICARE: CHERYL ANNE DEMILLE RN

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	163WL0100X	Lactation Consultant (Registered Nurse)	212153-3102	UT

General Provider Information

NPI Number	:	1770755977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL ANNE DEMILLE RN

Provider Business Mailing Address
First Line	:	5121 SOUTH COTTONWOOD STREET
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84157-7000
Country	:	US
Telephone Number	:	801-507-7661
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 SOUTH COTTONWOOD STREET
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84157-7000
Country	:	US
Telephone Number	:	801-507-7661
Fax Number	:

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

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	03/27/2008

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