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NPI Code Detail

MEDICARE: CHERIE BOETTCHER CNM

MEDICARE: CHERIE BOETTCHER CNM
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
1176B00000XMidwife248188TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
186N553OTHERTXBCBS
263665OTHERTXGREAT-WEST NATIONAL ACCT.
380705OTHERTXGREAT-WEST HEALTHCARE
44581569OTHERTXAETNA

General Provider Information

NPI Number : 1689883472
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERIE BOETTCHER CNM
Provider Business Mailing Address
First Line : 3100 SWISS AVE
Second Line :
City : DALLAS
State : TX
Zip : 75204-6025
Country : US
Telephone Number : 214-821-8190
Fax Number : 214-821-9040
Provider Business Practice Location Address
First Line : 3100 SWISS AVE
Second Line :
City : DALLAS
State : TX
Zip : 75204-6025
Country : US
Telephone Number : 214-821-8190
Fax Number : 214-821-9040
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2007
Last Update Date : 07/08/2007

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Directions to “ CHERIE BOETTCHER CNM” Practice Location

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