Healthcare Provider Details

I. General information

NPI: 1851551634
Provider Name (Legal Business Name): CHERI E HOUGLAND PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2008
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9164 DESCHUTES RD
PALO CEDRO CA
96073-8732
US

IV. Provider business mailing address

3082 MCMURRAY DR
ANDERSON CA
96007-3544
US

V. Phone/Fax

Practice location:
  • Phone: 530-547-4477
  • Fax:
Mailing address:
  • Phone: 530-365-4420
  • Fax: 530-365-5186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15953
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: