Provider Demographics
NPI:1871938787
Name:ATINE, CHERYL (ADC II)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:ATINE
Suffix:
Gender:F
Credentials:ADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 SHOSHONE CIR
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-5072
Mailing Address - Country:US
Mailing Address - Phone:775-748-1426
Mailing Address - Fax:
Practice Address - Street 1:515 SHOSHONE CIR
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-5072
Practice Address - Country:US
Practice Address - Phone:775-748-1426
Practice Address - Fax:775-738-4219
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ646261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV00470420Medicaid