Provider Demographics
NPI:1316237639
Name:VENTRA, CECELIA B (LPN)
Entity type:Individual
Prefix:
First Name:CECELIA
Middle Name:B
Last Name:VENTRA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PIXLEY DR
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:NY
Mailing Address - Zip Code:13730-2300
Mailing Address - Country:US
Mailing Address - Phone:607-745-5136
Mailing Address - Fax:
Practice Address - Street 1:1 PIXLEY DR
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:NY
Practice Address - Zip Code:13730
Practice Address - Country:US
Practice Address - Phone:607-624-1709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290337164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse