Healthcare Provider Details

I. General information

NPI: 1821367681
Provider Name (Legal Business Name): CHERYL MAY TUBBS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W BUFFALO ST
ITHACA NY
14850-4124
US

IV. Provider business mailing address

1067 TRUMBULLS CORNERS RD
NEWFIELD NY
14867-9452
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-2210
  • Fax:
Mailing address:
  • Phone: 607-592-1819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number373109-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: