Provider Demographics
NPI:1174079818
Name:CHERRY, DAWN B (ADMINISTRATOR)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:B
Last Name:CHERRY
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-0033
Mailing Address - Country:US
Mailing Address - Phone:252-325-4570
Mailing Address - Fax:
Practice Address - Street 1:1001 S KING ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-9604
Practice Address - Country:US
Practice Address - Phone:252-325-4570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC130710163WA2000X
NC172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No172V00000XOther Service ProvidersCommunity Health Worker