1336422120 NPI number — CHERYL LYNN RASH NURSE PRACTITIONER

Table of content: CHERYL LYNN RASH NURSE PRACTITIONER (NPI 1336422120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336422120 NPI number — CHERYL LYNN RASH NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RASH
Provider First Name:
CHERYL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
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:
1336422120
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
906 LAKEVIEW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19963-1732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-684-4950
Provider Business Mailing Address Fax Number:
302-684-8931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21444 CARMEAN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19947-4572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-855-1233
Provider Business Practice Location Address Fax Number:
302-855-1020
Provider Enumeration Date:
09/28/2011

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: 163WS0200X , with the licence number:  L10023286 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: LG0001222 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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