Provider Demographics
NPI:1497067029
Name:AMBROSONE, CHERYL (LPN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:AMBROSONE
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 1:7625 RANDALLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HAMMONDSPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14840-9578
Mailing Address - Country:US
Mailing Address - Phone:607-569-2974
Mailing Address - Fax:
Practice Address - Street 1:7625 RANDALLVILLE RD
Practice Address - Street 2:
Practice Address - City:HAMMONDSPORT
Practice Address - State:NY
Practice Address - Zip Code:14840-9578
Practice Address - Country:US
Practice Address - Phone:607-569-2974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121605-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse