Provider Demographics
NPI:1093298283
Name:DESHONG, CHERRIEE MILYNN (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:CHERRIEE
Middle Name:MILYNN
Last Name:DESHONG
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:CHERRIEE
Other - Middle Name:
Other - Last Name:GLASSCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22907 W HOPI ST
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-8614
Mailing Address - Country:US
Mailing Address - Phone:623-826-3033
Mailing Address - Fax:
Practice Address - Street 1:6601 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-5700
Practice Address - Country:US
Practice Address - Phone:602-243-7277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11764363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ428718Medicaid