Provider Demographics
NPI:1306887120
Name:SANTA, CHERYL COUNTS (LPN)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:COUNTS
Last Name:SANTA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:COUNTS
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:9741 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-9432
Mailing Address - Country:US
Mailing Address - Phone:740-892-2270
Mailing Address - Fax:
Practice Address - Street 1:1147 CLARE ST
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062
Practice Address - Country:US
Practice Address - Phone:614-577-0903
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN070201164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2582638Medicaid