Basic Information
Provider Information
NPI: 1376777458
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROTHWELL
FirstName: CHERYL
MiddleName: ANN
NamePrefix: MS.
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 47 OBERY ST STE 1A
Address2:  
City: PLYMOUTH
State: MA
PostalCode: 023602230
CountryCode: US
TelephoneNumber: 5087474883
FaxNumber: 5087476661
Practice Location
Address1: 5 INDUSTRIAL DRIVE
Address2: MASHPEE FAMILY MEDICINE SUITE 100
City: MASHPEE
State: MA
PostalCode: 02649
CountryCode: US
TelephoneNumber: 5084774282
FaxNumber: 5085396134
Other Information
ProviderEnumerationDate: 05/05/2009
LastUpdateDate: 10/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/11/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200X234187MAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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