Provider Demographics
NPI:1326341082
Name:CERACCHE, CINDY L (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:CERACCHE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 WINTRHOP DRIVE
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-266-3559
Mailing Address - Fax:607-257-8157
Practice Address - Street 1:425 WINTRHOP DRIVE
Practice Address - Street 2:NORTHEAST ELEMENTARY SCHOOL
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-266-3559
Practice Address - Fax:607-257-8157
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296600-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse