Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP11764 | AZ |
NPI | 1093298283 |
---|---|
Provider Name | Mrs. Cherriee Milynn Deshong |
First Address | Buckeye, AZ 85326-8614 |
Second Address | Phoenix, AZ 85033-5700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2018 |
Last Update Date | 08/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
428718 | (05) | AZ |