Individual
MS. CHERYL L. PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1456 BURLINGHAM RD, PO # 1462 PINE BUSH NY 12566, PINE BUSH, NY 12566-7364
(845) 283-4024
Mailing address
PO BOX 1462, 1456 BURLINGHAM RD., PINE BUSH, NY 12566-1462
(845) 283-4024
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
167402-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02780523
—
NY
Enumeration date
03/26/2008
Last updated
03/26/2008
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