Provider Demographics
NPI:1548760408
Name:MASTERS, CHERYL
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:MASTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75429-0781
Mailing Address - Country:US
Mailing Address - Phone:903-886-4324
Mailing Address - Fax:
Practice Address - Street 1:6037 PRIVATE ROAD 4226
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:TX
Practice Address - Zip Code:75422-2290
Practice Address - Country:US
Practice Address - Phone:903-886-4324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301178164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse