Provider Demographics
NPI:1679803571
Name:RADER, CHERYL LEE (RN)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LEE
Last Name:RADER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:CHERYL
Other - Middle Name:LEE
Other - Last Name:ROCKHOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2116 NE WATERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-1857
Mailing Address - Country:US
Mailing Address - Phone:816-229-9208
Mailing Address - Fax:
Practice Address - Street 1:2116 NE WATERFIELD PL
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-1857
Practice Address - Country:US
Practice Address - Phone:816-229-9208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO080255163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine