Provider Demographics
NPI:1821367681
Name:TUBBS, CHERYL MAY (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:MAY
Last Name:TUBBS
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 1:1067 TRUMBULLS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:NEWFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14867-9452
Mailing Address - Country:US
Mailing Address - Phone:607-592-1819
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY373109-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse