Provider Demographics
NPI:1619213139
Name:TAETSCH, CHERE NICOLE (RN)
Entity Type:Individual
Prefix:
First Name:CHERE
Middle Name:NICOLE
Last Name:TAETSCH
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 1:5334 ALFONSO DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4062
Mailing Address - Country:US
Mailing Address - Phone:818-451-3992
Mailing Address - Fax:
Practice Address - Street 1:30765 PACIFIC COAST HWY
Practice Address - Street 2:STE 376
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3646
Practice Address - Country:US
Practice Address - Phone:888-958-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-02
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA660647163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse