Provider Demographics
NPI:1104229228
Name:TETEN, SHERRI
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:TETEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 E LAKE MEAD BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7187
Mailing Address - Country:US
Mailing Address - Phone:702-655-2308
Mailing Address - Fax:702-655-2344
Practice Address - Street 1:1815 E LAKE MEAD BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7187
Practice Address - Country:US
Practice Address - Phone:702-655-2308
Practice Address - Fax:702-655-2344
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV47-1634550291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory