Provider Demographics
NPI:1891849667
Name:ARCHULETA, CHERYL MARIE (PAC)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:MARIE
Last Name:ARCHULETA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N 1ST ST STE 240
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6132
Mailing Address - Country:US
Mailing Address - Phone:208-338-8900
Mailing Address - Fax:208-947-1190
Practice Address - Street 1:333 N 1ST ST STE 240
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-338-8900
Practice Address - Fax:208-947-1190
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant