Provider Demographics
NPI:1992170302
Name:WHIPPLE, CHERYL (APRN)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:WHIPPLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:MAKARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:1000 SILVER ST.
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-7023
Mailing Address - Country:US
Mailing Address - Phone:860-262-6473
Mailing Address - Fax:860-262-5638
Practice Address - Street 1:1000 SILVER STREET
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-7023
Practice Address - Country:US
Practice Address - Phone:860-262-6473
Practice Address - Fax:860-262-5638
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE52483163WP0808X
CT005033363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health