Provider Demographics
NPI:1063588911
Name:CHERRY, MCLEAN (MSN WHNP FNP)
Entity type:Individual
Prefix:
First Name:MCLEAN
Middle Name:
Last Name:CHERRY
Suffix:
Gender:F
Credentials:MSN WHNP FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 978
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-0978
Mailing Address - Country:US
Mailing Address - Phone:423-834-6193
Mailing Address - Fax:
Practice Address - Street 1:605 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1670
Practice Address - Country:US
Practice Address - Phone:970-925-8005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO115978363LF0000X, 363LW0102X
TN13233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COQ21247Medicare UPIN