Provider Demographics
NPI:1659688836
Name:IMOE, CHERI MARLENE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:CHERI
Middle Name:MARLENE
Last Name:IMOE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 W TAYLOR ST SPC 364A
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-1029
Mailing Address - Country:US
Mailing Address - Phone:805-361-0288
Mailing Address - Fax:
Practice Address - Street 1:519 W TAYLOR ST SPC 364A
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-1029
Practice Address - Country:US
Practice Address - Phone:805-361-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN43117164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse