Provider Demographics
NPI:1992314405
Name:MORTIMER, CHERYL (RN)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:MORTIMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 LEGACY LN APT 130
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-1832
Mailing Address - Country:US
Mailing Address - Phone:719-235-0941
Mailing Address - Fax:
Practice Address - Street 1:2200 LEGACY LN APT 130
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-1832
Practice Address - Country:US
Practice Address - Phone:719-235-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX535073163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse