Provider Demographics
NPI:1689883472
Name:BOETTCHER, CHERIE (CNM)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:
Last Name:BOETTCHER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SWISS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6025
Mailing Address - Country:US
Mailing Address - Phone:214-821-8190
Mailing Address - Fax:214-821-9040
Practice Address - Street 1:3100 SWISS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6025
Practice Address - Country:US
Practice Address - Phone:214-821-8190
Practice Address - Fax:214-821-9040
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248188176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86N553OtherBCBS
TX63665OtherGREAT-WEST NATIONAL ACCT.
TX80705OtherGREAT-WEST HEALTHCARE
TX4581569OtherAETNA