Provider Demographics
NPI:1659118214
Name:POTTER, CHERYL KEHAU (LABORATORY ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:KEHAU
Last Name:POTTER
Suffix:
Gender:F
Credentials:LABORATORY ASSISTANT
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2591
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89041-2591
Mailing Address - Country:US
Mailing Address - Phone:808-740-8502
Mailing Address - Fax:
Practice Address - Street 1:70 SOUTH HIGHWAY160
Practice Address - Street 2:#104
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048
Practice Address - Country:US
Practice Address - Phone:808-740-8502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV78685-AL-0246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy