Provider Demographics
NPI:1467663609
Name:ROTH, CHERYL KAY (RNC, MSN, WHNP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:KAY
Last Name:ROTH
Suffix:
Gender:F
Credentials:RNC, MSN, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1014 S SLATER CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-5810
Mailing Address - Country:US
Mailing Address - Phone:480-794-1746
Mailing Address - Fax:480-794-1746
Practice Address - Street 1:604 W WARNER RD STE E201
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2911
Practice Address - Country:US
Practice Address - Phone:480-963-7900
Practice Address - Fax:480-899-9954
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2715363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health