Provider Demographics
NPI:1770850620
Name:TRAVER, CHERYL R (RN)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:R
Last Name:TRAVER
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 1:170 STAGE RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-2607
Mailing Address - Country:US
Mailing Address - Phone:518-399-9141
Mailing Address - Fax:518-399-0227
Practice Address - Street 1:170 STAGE RD
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-2607
Practice Address - Country:US
Practice Address - Phone:518-399-9141
Practice Address - Fax:518-399-0227
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY566736-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool