Provider Demographics
NPI:1669979068
Name:UNDERWOOD, CHERYL (FNP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 CARPENTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-6096
Mailing Address - Country:US
Mailing Address - Phone:802-345-8161
Mailing Address - Fax:
Practice Address - Street 1:28 PARK AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-9701
Practice Address - Country:US
Practice Address - Phone:802-878-1008
Practice Address - Fax:802-872-2679
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0027479163WE0003X
VT101.0134237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT14413831Medicaid