Provider Demographics
NPI:1902053838
Name:ANDERSEN, CHERYL ANN (RN, PHN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 PACKARD AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-7118
Mailing Address - Country:US
Mailing Address - Phone:530-749-6454
Mailing Address - Fax:530-749-6366
Practice Address - Street 1:5730 PACKARD AVE
Practice Address - Street 2:STE. 100
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-7118
Practice Address - Country:US
Practice Address - Phone:530-749-6454
Practice Address - Fax:530-749-6366
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307673163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health