Provider Demographics
NPI:1912702556
Name:WARREN, CHERYL DALE
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:DALE
Last Name:WARREN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 ERICA DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8463
Mailing Address - Country:US
Mailing Address - Phone:503-839-2667
Mailing Address - Fax:
Practice Address - Street 1:REYNOLDS MIDDLE SCHOOL
Practice Address - Street 2:9507 BURNS RD
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301
Practice Address - Country:US
Practice Address - Phone:503-839-2667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61309979163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse