Provider Demographics
NPI:1427548957
Name:PAEZ, CHERLYN
Entity Type:Individual
Prefix:
First Name:CHERLYN
Middle Name:
Last Name:PAEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 E DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2437
Mailing Address - Country:US
Mailing Address - Phone:918-424-8406
Mailing Address - Fax:
Practice Address - Street 1:2406 E DEVINE ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2437
Practice Address - Country:US
Practice Address - Phone:918-424-8406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171804164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse