Provider Demographics
NPI:1497098305
Name:CARDAMONE-KNEWSTUB, CHEYENNE (RN)
Entity Type:Individual
Prefix:MISS
First Name:CHEYENNE
Middle Name:
Last Name:CARDAMONE-KNEWSTUB
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4124
Mailing Address - Country:US
Mailing Address - Phone:607-274-2210
Mailing Address - Fax:607-274-2196
Practice Address - Street 1:302 W BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4124
Practice Address - Country:US
Practice Address - Phone:607-274-2210
Practice Address - Fax:607-274-2196
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 658227163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool