| Doctor Name: | CHERYL M VAN LARE |
| NPI Number: | 1306906904 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | F330902-1 |
| Business Practice Address: | 350 New Campus Dr Hazen Student Health Center Brockport, NY - 144202997 |
| Business Phone Number: | 5853952414 |
| Business Fax Number: | |
| Mailing Address: | 80 Saint Paul St, Apt. 2g ROCHESTER |
| State: | NY |
| Postal Code: | 146041310 |
| Phone Number: | 5857048562 |
| Fax Number: | |
| NPI Enumeration Date: | 12/12/2006 |
| NPI Last Update Date: | 09/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F330902-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |