MEDICARE: SHERRI TETEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	47-1634550	NV

General Provider Information

NPI Number	:	1104229228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRI TETEN

Provider Business Mailing Address
First Line	:	1815 E LAKE MEAD BLVD
Second Line	:	SUITE 207
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7187
Country	:	US
Telephone Number	:	702-655-2308
Fax Number	:	702-655-2344

Provider Business Practice Location Address
First Line	:	1815 E LAKE MEAD BLVD
Second Line	:	SUITE 207
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7187
Country	:	US
Telephone Number	:	702-655-2308
Fax Number	:	702-655-2344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	10/02/2014

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Directions to “ SHERRI TETEN ” Practice Location

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