Provider Demographics
NPI:1427737659
Name:CHERRY, DAVID ORIN
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ORIN
Last Name:CHERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 N CONVENT ST
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1332
Mailing Address - Country:US
Mailing Address - Phone:815-802-0088
Mailing Address - Fax:815-935-1000
Practice Address - Street 1:662 N CONVENT ST
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1332
Practice Address - Country:US
Practice Address - Phone:815-802-0088
Practice Address - Fax:815-935-1000
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.402556163WE0003X
IL209028218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency