Provider Demographics
NPI:1871817486
Name:CHERISE FNP-BC
Entity Type:Organization
Organization Name:CHERISE FNP-BC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:CHERISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUDAU-BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:361-920-3145
Mailing Address - Street 1:PO BOX 6696
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-6696
Mailing Address - Country:US
Mailing Address - Phone:361-985-1221
Mailing Address - Fax:361-992-1667
Practice Address - Street 1:191 HURON ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77905-3785
Practice Address - Country:US
Practice Address - Phone:361-920-3145
Practice Address - Fax:361-992-1667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX572524363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty