Provider Demographics
NPI:1114195674
Name:TERRY, CHERISE N (RN, MSN, PNP)
Entity Type:Individual
Prefix:MS
First Name:CHERISE
Middle Name:N
Last Name:TERRY
Suffix:
Gender:F
Credentials:RN, MSN, PNP
Other - Prefix:
Other - First Name:CHERISE
Other - Middle Name:N
Other - Last Name:LUEDTKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, PNP
Mailing Address - Street 1:3075 SAGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-8721
Mailing Address - Country:US
Mailing Address - Phone:562-458-7052
Mailing Address - Fax:
Practice Address - Street 1:3075 SAGEWOOD LANE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882
Practice Address - Country:US
Practice Address - Phone:562-458-7052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17528363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics