Provider Demographics
NPI:1073788337
Name:EVELAND, CHEREE L (CST)
Entity Type:Individual
Prefix:
First Name:CHEREE
Middle Name:L
Last Name:EVELAND
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 WOODMONT DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1166
Mailing Address - Country:US
Mailing Address - Phone:208-631-8912
Mailing Address - Fax:
Practice Address - Street 1:3455 WOODMONT DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1166
Practice Address - Country:US
Practice Address - Phone:208-631-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID93758174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist