Healthcare Provider Details

I. General information

NPI: 1972718476
Provider Name (Legal Business Name): CHERI COURREGE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 E FRY BLVD
SIERRA VISTA AZ
85635-2972
US

IV. Provider business mailing address

5570 LOS CAPANOS DRIVE
SIERRA VISTA AZ
85635
US

V. Phone/Fax

Practice location:
  • Phone: 520-515-2918
  • Fax:
Mailing address:
  • Phone: 520-515-2918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN140636
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: