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General NPI Number Information
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NPI Number | 1851988604
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Entity Type | Individual
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Provider Name | CHERISHE PAYNE MONDICS
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Gender | Female
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Dates
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Enumeration Date | 12/28/2020
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 2801 BOLTON BOONE DR
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City | DESOTO
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State | TX
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Zip | 75115-2041
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Country | US
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Telephone | 972-298-6677
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Fax |
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Provider Business Mailing Address
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Address Line | 139 OREGON TRL
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City | WAXAHACHIE
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State | TX
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Zip | 75167-4802
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Country | US
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Telephone | 806-239-5716
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP1017566
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License Number State | TX
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