Provider Demographics
NPI:1518571660
Name:MOUTON, CHERIE AMOUR (RN)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:AMOUR
Last Name:MOUTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43854 46TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-2365
Mailing Address - Country:US
Mailing Address - Phone:661-860-0557
Mailing Address - Fax:
Practice Address - Street 1:43854 46TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-2365
Practice Address - Country:US
Practice Address - Phone:661-860-0557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-06
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028322363LP0808X
CA792318163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant