Provider Demographics
NPI:1285395244
Name:DEBLASSIE, CHERRO (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:CHERRO
Middle Name:
Last Name:DEBLASSIE
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4764 E BONANZA RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7453
Mailing Address - Country:US
Mailing Address - Phone:505-544-6592
Mailing Address - Fax:
Practice Address - Street 1:4764 E BONANZA RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7453
Practice Address - Country:US
Practice Address - Phone:505-544-6592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261166163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant