Provider Demographics
NPI:1205254745
Name:CHERRICO, MARY (RN, ARNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CHERRICO
Suffix:
Gender:F
Credentials:RN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 FALCON DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2636
Mailing Address - Country:US
Mailing Address - Phone:319-393-6538
Mailing Address - Fax:
Practice Address - Street 1:200 HAWKINS DR. E 257 GH/
Practice Address - Street 2:UNIVERSITY OF IOWA/CPH/PREVENTIVE INTERVENTION CENTER
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52252
Practice Address - Country:US
Practice Address - Phone:319-384-5030
Practice Address - Fax:319-384-5045
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080578163W00000X
IAA-080578363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse