Provider Demographics
NPI:1487906673
Name:LEE, CHERRY M (NP)
Entity type:Individual
Prefix:
First Name:CHERRY
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10161 PARK RUN DR SUITE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145
Mailing Address - Country:US
Mailing Address - Phone:408-833-3158
Mailing Address - Fax:702-515-7400
Practice Address - Street 1:10161 PARK RUN DR SUITE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145
Practice Address - Country:US
Practice Address - Phone:408-833-3158
Practice Address - Fax:702-515-7400
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001425363L00000X, 363L00000X
NVAPN001425363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1487906673Medicaid
NVGZ285ZMedicare PIN
NVGZ285YMedicare PIN