MEDICARE: PROF. CHERIE ANN SOPRANO PHD RN, PMHNP-BC

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP007052	PA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN001827	NV

General Provider Information

NPI Number	:	1295081776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. CHERIE ANN SOPRANO PHD RN, PMHNP-BC

Provider Business Mailing Address
First Line	:	260 JOVITA CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-5230
Country	:	US
Telephone Number	:	570-881-3425
Fax Number	:

Provider Business Practice Location Address
First Line	:	2332 N LAS VEGAS BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-5856
Country	:	US
Telephone Number	:	570-383-9934
Fax Number	:	570-230-0013

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2012
Last Update Date	:	07/13/2021

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