Basic Information
| Provider Information | |||||||||
| NPI: | 1164508537 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOVALENKO | ||||||||
| FirstName: | CHERI | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5816 W KING ARTHUR DR | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571060675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053616055 | ||||||||
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| Practice Location | |||||||||
| Address1: | 911 E 20TH ST | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053223440 | ||||||||
| FaxNumber: | 6053223654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R033474 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 6825360 | 05 | SD | MEDICAID |