Provider Demographics
NPI:1083733976
Name:DRAPER, CHERYL ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:DRAPER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7172 COUNTY ROUTE 13
Mailing Address - Street 2:P.O. BOX 814
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-7901
Mailing Address - Country:US
Mailing Address - Phone:607-776-6501
Mailing Address - Fax:
Practice Address - Street 1:7172 COUNTY ROUTE 13
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-7901
Practice Address - Country:US
Practice Address - Phone:607-776-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158810-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01196038Medicaid
NY158810-1OtherNYS NURSING LICENCE NUMER