Provider Demographics
NPI:1841377496
Name:BLANK, CHERIE L (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CHERIE
Middle Name:L
Last Name:BLANK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 490 BOX 9095
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96538
Mailing Address - Country:UM
Mailing Address - Phone:671-344-9679
Mailing Address - Fax:671-344-9305
Practice Address - Street 1:PSC 490 BOX 9095
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96538
Practice Address - Country:UM
Practice Address - Phone:671-344-9679
Practice Address - Fax:671-344-9305
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3191872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily