MEDICARE: CHERE VASSELL RN, MSN

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	163W00000X	Registered Nurse	95063367	CA
2	163W00000X	Registered Nurse	0001196283	VA
3	163W00000X	Registered Nurse	RN9317859	FL

General Provider Information

NPI Number	:	1619333895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERE VASSELL RN, MSN

Provider Business Mailing Address
First Line	:	3216 MURRAY RIDGE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2254
Country	:	US
Telephone Number	:	757-941-7688
Fax Number	:

Provider Business Practice Location Address
First Line	:	3216 MURRAY RIDGE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2254
Country	:	US
Telephone Number	:	757-941-7688
Fax Number	:

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

Provider Enumeration Date	:	01/04/2016
Last Update Date	:	01/04/2016

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