Provider Demographics
NPI:1528640281
Name:IRONHAWK, CHERYL ANN
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:IRONHAWK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:FORT TOTTEN
Mailing Address - State:ND
Mailing Address - Zip Code:58335-0591
Mailing Address - Country:US
Mailing Address - Phone:701-230-7960
Mailing Address - Fax:
Practice Address - Street 1:1015 BELLILE ST
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:ND
Practice Address - Zip Code:58370-7010
Practice Address - Country:US
Practice Address - Phone:701-230-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant