Healthcare Provider Details

I. General information

NPI: 1134224454
Provider Name (Legal Business Name): CHERYLE ANN WING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MAREBLU
ALISO VIEJO CA
92656-3014
US

IV. Provider business mailing address

24312 DE LEON DR
DANA POINT CA
92629-1608
US

V. Phone/Fax

Practice location:
  • Phone: 949-643-6905
  • Fax:
Mailing address:
  • Phone: 949-493-7633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number396501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: