1437227170 NPI number — MRS. CHERYL LYNN CHESNUT FNP-C, CNM

Table of content: MRS. CHERYL LYNN CHESNUT FNP-C, CNM (NPI 1437227170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437227170 NPI number — MRS. CHERYL LYNN CHESNUT FNP-C, CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHESNUT
Provider First Name:
CHERYL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C, CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437227170
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:
PO BOX 648
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SWINK
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81077-0648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
171-938-3085
Provider Business Mailing Address Fax Number:
171-938-3085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30999 COUNTY ROAD 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT LYON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
171-945-6341
Provider Business Practice Location Address Fax Number:
171-794-5635
Provider Enumeration Date:
12/01/2006

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: 367A00000X , with the licence number:  86182 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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