Provider Demographics
NPI:1871891978
Name:NORTHAM, CHERYL ANN (RN)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:NORTHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 UPLAND RD
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NH
Mailing Address - Zip Code:03811-2542
Mailing Address - Country:US
Mailing Address - Phone:603-362-5395
Mailing Address - Fax:
Practice Address - Street 1:14 UPLAND RD
Practice Address - Street 2:
Practice Address - City:ATKINSON
Practice Address - State:NH
Practice Address - Zip Code:03811-2542
Practice Address - Country:US
Practice Address - Phone:603-362-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN200832163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA100029755509Medicaid