Individual
CHERYL PROVENCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
15 FORTUNE RD W, MIDDLETOWN, NY 10941-1625
(518) 477-0156
Mailing address
15 FORTUNE RD W, MIDDLETOWN, NY 10941-1625
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
24706801
NY
Other
Enumeration date
11/16/2021
Last updated
11/16/2021
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