Provider Demographics
NPI:1235473497
Name:LADOUCEUR, CHERYL ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:LADOUCEUR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:WARNOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:331 LAKESIDE RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13209-9729
Mailing Address - Country:US
Mailing Address - Phone:315-317-6142
Mailing Address - Fax:
Practice Address - Street 1:331 LAKESIDE RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13209-9729
Practice Address - Country:US
Practice Address - Phone:315-317-6142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-11
Last Update Date:2012-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY633800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse