Provider Demographics
NPI:1780672089
Name:ANDERSEN, CHERRIE A (MD)
Entity Type:Individual
Prefix:
First Name:CHERRIE
Middle Name:A
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:707-444-9664
Mailing Address - Fax:707-444-8747
Practice Address - Street 1:2773 HARRIS STREET
Practice Address - Street 2:SUITE A
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4886
Practice Address - Country:US
Practice Address - Phone:707-444-9664
Practice Address - Fax:707-444-8747
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53065207V00000X
AZ25910207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG81103Medicare UPIN