Provider Demographics
NPI:1730197278
Name:HENRY, CHERYL (NP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:HENRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 E MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48621-8731
Mailing Address - Country:US
Mailing Address - Phone:989-848-5644
Mailing Address - Fax:989-848-7411
Practice Address - Street 1:1910 E MILLER RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:MI
Practice Address - Zip Code:48621-8731
Practice Address - Country:US
Practice Address - Phone:989-848-5644
Practice Address - Fax:989-848-7411
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704230124363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P03370Medicare ID - Type Unspecified
Q42640Medicare UPIN