Provider Demographics
NPI:1396196598
Name:DEFREZE, CHERYL (LPN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:DEFREZE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:CROCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:28 PINE ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1429
Mailing Address - Country:US
Mailing Address - Phone:607-661-2248
Mailing Address - Fax:
Practice Address - Street 1:28 PINE ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1429
Practice Address - Country:US
Practice Address - Phone:607-661-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275616-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse