Provider Demographics
NPI:1699502062
Name:TIPTON, CHERMAINE ANITA (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:CHERMAINE
Middle Name:ANITA
Last Name:TIPTON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2155 CHICAGO AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2209
Mailing Address - Country:US
Mailing Address - Phone:909-966-4553
Mailing Address - Fax:909-966-4069
Practice Address - Street 1:2155 CHICAGO AVE STE 201
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2209
Practice Address - Country:US
Practice Address - Phone:909-966-4553
Practice Address - Fax:909-966-4069
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98306854163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse