Basic Information
Provider Information
NPI: 1003012667
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NIENOW
FirstName: CHERIE
MiddleName: S.
NamePrefix:  
NameSuffix:  
Credential: RN, CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: CANFIELD
OtherFirstName: CHERIE
OtherMiddleName: S.
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 166 4TH ST E
Address2:  
City: SAINT PAUL
State: MN
PostalCode: 551011421
CountryCode: US
TelephoneNumber: 6512922043
FaxNumber: 6512922204
Practice Location
Address1: 166 4TH ST E
Address2:  
City: SAINT PAUL
State: MN
PostalCode: 551011421
CountryCode: US
TelephoneNumber: 6512922043
FaxNumber: 6512922204
Other Information
ProviderEnumerationDate: 06/21/2007
LastUpdateDate: 06/10/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XR 125335-1MNY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

ID Information
IDTypeStateIssuerDescription
48846700005MN MEDICAID


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