Provider Demographics
NPI:1700690229
Name:EDADES, CHERISH CABANILLA
Entity type:Individual
Prefix:
First Name:CHERISH
Middle Name:CABANILLA
Last Name:EDADES
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 1:9965 TUCKET POINT CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-2464
Mailing Address - Country:US
Mailing Address - Phone:907-350-0396
Mailing Address - Fax:
Practice Address - Street 1:9965 TUCKET POINT CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-2464
Practice Address - Country:US
Practice Address - Phone:907-350-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029931363LF0000X
NV860732363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily