MEDICARE: CHERYL LYNN DUBOSE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	26NO09384700	NJ

General Provider Information

NPI Number	:	1215769476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL LYNN DUBOSE RN

Provider Business Mailing Address
First Line	:	34 LEBANON RD
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-6123
Country	:	US
Telephone Number	:	609-247-9621
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 OLD MARLTON PIKE STE 124
Second Line	:
City	:	MEDFORD
State	:	NJ
Zip	:	08055-8772
Country	:	US
Telephone Number	:	888-575-9162
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2024
Last Update Date	:	08/16/2024

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