MEDICARE: MS. CHERYL LYNN JETER FNP-C

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	363LF0000X	Family Nurse Practitioner	0024164767	VA

General Provider Information

NPI Number	:	1801078696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL LYNN JETER FNP-C

Provider Business Mailing Address
First Line	:	1133 FIRST COLONIAL ROAD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2402
Country	:	US
Telephone Number	:	757-496-2050
Fax Number	:	757-689-4357

Provider Business Practice Location Address
First Line	:	1133 FIRST COLONIAL ROAD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2402
Country	:	US
Telephone Number	:	757-496-2050
Fax Number	:	757-689-4357

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

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	11/10/2009

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