Individual
CHERYL JEAN DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CHP
Contact information
Practice address
110 MAIN STREET, AMBLER, AK 99786-0110
(907) 445-2129
(907) 445-2179
Mailing address
110 MAIN STREET, AMBLER, AK 99786-0110
(907) 445-2129
(907) 445-2179
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
10-1057-II
AK
Other
Enumeration date
11/28/2011
Last updated
11/28/2011
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