Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 115978 | CO |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 13233 | TN |
N | 363LW0102X | Nurse Practitioner - Women's Health | 115978 | CO |
NPI | 1063588911 |
---|---|
Provider Name | Mclean Cherry |
First Address | Basalt, CO 81621-0978 |
Second Address | Aspen, CO 81611-1670 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2006 |
Last Update Date | 22/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q21247 | (02) | CO |