Healthcare Provider Details

I. General information

NPI: 1518571660
Provider Name (Legal Business Name): CHERIE AMOUR MOUTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2020
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43854 46TH ST W
LANCASTER CA
93536-2365
US

IV. Provider business mailing address

43854 46TH ST W
LANCASTER CA
93536-2365
US

V. Phone/Fax

Practice location:
  • Phone: 661-860-0557
  • Fax:
Mailing address:
  • Phone: 661-860-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95028322
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number792318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: