Provider Demographics
NPI:1346695384
Name:PETERSON, CHERYLE NICHOLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CHERYLE
Middle Name:NICHOLE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHERYLE
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CHERYLE GATEWOOD
Mailing Address - Street 1:9982 SHADOW LANDING AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-5144
Mailing Address - Country:US
Mailing Address - Phone:702-373-2231
Mailing Address - Fax:
Practice Address - Street 1:6433 CORRIE CANYON ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-1411
Practice Address - Country:US
Practice Address - Phone:702-373-2231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002163282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1346695384Medicaid