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NPI Code Detail

MEDICARE: CHERYL E. DETERS

MEDICARE: CHERYL E. DETERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse PractitionerRN240289CA

General Provider Information

NPI Number : 1124181474
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERYL E. DETERS
Provider Business Mailing Address
First Line : PO BOX 18563
Second Line :
City : ANAHEIM
State : CA
Zip : 92817-8563
Country : US
Telephone Number : 562-304-3317
Fax Number :
Provider Business Practice Location Address
First Line : 233 S QUINTANA DR
Second Line :
City : ANAHEIM
State : CA
Zip : 92807-4029
Country : US
Telephone Number : 714-282-2829
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2006
Last Update Date : 07/08/2007

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