Provider Demographics
NPI:1497015838
Name:WAGAHOFT, CHERIE (ANP-BC)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:
Last Name:WAGAHOFT
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 PROVIDENCE DR STE 452
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4628
Mailing Address - Country:US
Mailing Address - Phone:907-562-2120
Mailing Address - Fax:907-562-6527
Practice Address - Street 1:3340 PROVIDENCE DR STE 452
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4628
Practice Address - Country:US
Practice Address - Phone:907-562-2120
Practice Address - Fax:907-562-6527
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1290363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner