Provider Demographics
NPI:1588490684
Name:WALL, CHERYL (RN BSN CFCN)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:WALL
Suffix:
Gender:F
Credentials:RN BSN CFCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 LEE ST
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-3253
Mailing Address - Country:US
Mailing Address - Phone:781-975-1610
Mailing Address - Fax:
Practice Address - Street 1:66 LEE ST
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-3253
Practice Address - Country:US
Practice Address - Phone:781-975-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA253471163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice