Provider Demographics
NPI:1437958782
Name:HAIRISENHALL, CHERIE LYNN
Entity type:Individual
Prefix:
First Name:CHERIE
Middle Name:LYNN
Last Name:HAIRISENHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1222
Mailing Address - Country:US
Mailing Address - Phone:419-708-9455
Mailing Address - Fax:
Practice Address - Street 1:1615 TIMBER WOLF DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8304
Practice Address - Country:US
Practice Address - Phone:419-863-1512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty