Provider Demographics
NPI:1346354701
Name:WIRTH, CHERYL ANN (RN,FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:WIRTH
Suffix:
Gender:F
Credentials:RN,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18230 FM 1488 RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4530
Mailing Address - Country:US
Mailing Address - Phone:281-356-2525
Mailing Address - Fax:281-356-2920
Practice Address - Street 1:18230 FM 1488 RD STE 200
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-4530
Practice Address - Country:US
Practice Address - Phone:281-356-2525
Practice Address - Fax:281-356-2920
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0276822-22363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0276822-22OtherCFNP LICENSE
TXP34276Medicare UPIN
TX0276822-22OtherCFNP LICENSE