Provider Demographics
NPI:1386072965
Name:PUSHCAR, CHERYL
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:PUSHCAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:A
Other - Last Name:PUSHCAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 20970
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7020
Mailing Address - Country:US
Mailing Address - Phone:307-996-4777
Mailing Address - Fax:307-773-8013
Practice Address - Street 1:800 E 20TH STREET STE 350
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3882
Practice Address - Country:US
Practice Address - Phone:307-996-1560
Practice Address - Fax:307-996-1565
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY19553.1269363L00000X
WY1269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner