Provider Demographics
NPI:1437196284
Name:VADER, CHERYL ANN (APNP)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:VADER
Suffix:
Gender:F
Credentials:APNP
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Mailing Address - Street 1:PO BOX 6514
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49696-6514
Mailing Address - Country:US
Mailing Address - Phone:989-340-1211
Mailing Address - Fax:989-340-1214
Practice Address - Street 1:1721 S STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3637
Practice Address - Country:US
Practice Address - Phone:906-774-1313
Practice Address - Fax:989-340-1214
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-12-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI2686-033363LA2200X
MI4704143343363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health