Provider Demographics
NPI:1215198973
Name:LOLOS, CHERYL L (CRNA)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:LOLOS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15501 CRATER DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5119
Mailing Address - Country:US
Mailing Address - Phone:314-901-5082
Mailing Address - Fax:
Practice Address - Street 1:15501 CRATER DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5119
Practice Address - Country:US
Practice Address - Phone:314-901-5082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001018534367500000X
IL041410707367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0400114947Medicare NSC