Provider Demographics
NPI:1902125420
Name:PROFFER, CHERI MAY
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:MAY
Last Name:PROFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11719 STATE HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63766-6126
Mailing Address - Country:US
Mailing Address - Phone:573-243-5144
Mailing Address - Fax:
Practice Address - Street 1:11719 STATE HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63766-6126
Practice Address - Country:US
Practice Address - Phone:573-243-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide