Provider Demographics
NPI:1912746959
Name:NESTELROAD, CHERRE ANN
Entity type:Individual
Prefix:
First Name:CHERRE
Middle Name:ANN
Last Name:NESTELROAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHERRE
Other - Middle Name:ANN
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-2849
Mailing Address - Country:US
Mailing Address - Phone:316-304-2598
Mailing Address - Fax:
Practice Address - Street 1:1020 HARDING ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-2849
Practice Address - Country:US
Practice Address - Phone:316-304-2598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8494982893101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor