Provider Demographics
NPI:1588876031
Name:ELLIOTT, CHERYL MARIE (STNA)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:MARIE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6786 HEATHER MOOR TRL
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-9365
Mailing Address - Country:US
Mailing Address - Phone:937-509-4853
Mailing Address - Fax:
Practice Address - Street 1:6786 HEATHER MOOR TRL
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-9365
Practice Address - Country:US
Practice Address - Phone:937-509-4853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH365172810691376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2708038OtherIPN