Provider Demographics
NPI:1124616701
Name:BETHEL-PURPERO, CHERYL
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:BETHEL-PURPERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:BETHEL-PURPERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2216 LUNBECK RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8757
Mailing Address - Country:US
Mailing Address - Phone:740-253-6146
Mailing Address - Fax:
Practice Address - Street 1:2216 LUNBECK RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8757
Practice Address - Country:US
Practice Address - Phone:740-253-6146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2913851Medicaid