Basic Information
| Provider Information | |||||||||
| NPI: | 1306012372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOHANNES | ||||||||
| FirstName: | CHERI | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 COLTON AVE | ||||||||
| Address2: | |||||||||
| City: | LACKAWANNA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142181407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162762123 | ||||||||
| FaxNumber: | 7162762129 | ||||||||
| Practice Location | |||||||||
| Address1: | 2250 WEHRLE DR | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142217037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162762123 | ||||||||
| FaxNumber: | 7162762129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2008 | ||||||||
| LastUpdateDate: | 04/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 293060 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.