Provider Demographics
NPI:1023435260
Name:PRICKETT, CHERYLENE AQUINO (RN, MN)
Entity type:Individual
Prefix:
First Name:CHERYLENE
Middle Name:AQUINO
Last Name:PRICKETT
Suffix:
Gender:F
Credentials:RN, MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 DOODLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MATTHEWS
Mailing Address - State:SC
Mailing Address - Zip Code:29135-8202
Mailing Address - Country:US
Mailing Address - Phone:803-874-3630
Mailing Address - Fax:
Practice Address - Street 1:2837 OLD BELLEVILLE RD
Practice Address - Street 2:
Practice Address - City:SAINT MATTHEWS
Practice Address - State:SC
Practice Address - Zip Code:29135-9010
Practice Address - Country:US
Practice Address - Phone:803-874-2037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC49762163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health