1255321402 NPI number — MS. CHERYL S CERUTTI CRNA

Table of content: MS. CHERYL S CERUTTI CRNA (NPI 1255321402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255321402 NPI number — MS. CHERYL S CERUTTI CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CERUTTI
Provider First Name:
CHERYL
Provider Middle Name:
S
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DANISHEVSKY
Provider Other First Name:
CHERYL
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255321402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12303 DELPAUL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGETON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-344-7049
Provider Business Mailing Address Fax Number:
314-344-7073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12303 DELPAUL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGETON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-344-7049
Provider Business Practice Location Address Fax Number:
314-344-7073
Provider Enumeration Date:
10/27/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN067117 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 367500000X , with the licence number: 067117 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)