MEDICARE: CHERYL LYNN EUBANKS

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	3747A0650X	Attendant Care Provider		MO

General Provider Information

NPI Number	:	1891395893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL LYNN EUBANKS

Provider Business Mailing Address
First Line	:	1710 MCCASLAND AVE
Second Line	:
City	:	EAST SAINT LOUIS
State	:	IL
Zip	:	62207-2245
Country	:	US
Telephone Number	:	618-823-1905
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 MCCASLAND AVE
Second Line	:
City	:	EAST SAINT LOUIS
State	:	IL
Zip	:	62207-2245
Country	:	US
Telephone Number	:	618-823-1905
Fax Number	:

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

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	10/28/2020

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