Provider Demographics
NPI:1538804604
Name:UNDERWOOD, CHERYL YVONNE (RN)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:YVONNE
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 SANDIA VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-8716
Mailing Address - Country:US
Mailing Address - Phone:727-510-7934
Mailing Address - Fax:
Practice Address - Street 1:2600 MARBLE AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2058
Practice Address - Country:US
Practice Address - Phone:928-729-8000
Practice Address - Fax:505-272-9843
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM78994163WP2201X, 163WP0809X
FLRN3384592163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory