Provider Demographics
NPI:1194904656
Name:MAES, CHERYL A (APN, PHD)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:A
Last Name:MAES
Suffix:
Gender:F
Credentials:APN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 S DURANGO DR STE 2
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9186
Mailing Address - Country:US
Mailing Address - Phone:702-483-2407
Mailing Address - Fax:702-589-9421
Practice Address - Street 1:3012 S DURANGO DR STE 2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-483-2407
Practice Address - Fax:702-589-9421
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
V105324Medicare PIN