Healthcare Provider Details

I. General information

NPI: 1285395244
Provider Name (Legal Business Name): CHERRO DEBLASSIE RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4764 E BONANZA RD
GILBERT AZ
85297-7453
US

IV. Provider business mailing address

4764 E BONANZA RD
GILBERT AZ
85297-7453
US

V. Phone/Fax

Practice location:
  • Phone: 505-544-6592
  • Fax:
Mailing address:
  • Phone: 505-544-6592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number261166
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: