Provider Demographics
NPI:1053647933
Name:PUZIO, LORETTA CHERYL (NP)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:CHERYL
Last Name:PUZIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:9002 N. MERIDIAN
Practice Address - Street 2:SUITE 107
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-848-9441
Practice Address - Fax:317-924-8239
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71003094A363L00000X, 363LP0200X
IN28162888A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201144500Medicaid
ININ1127010OtherMEDICARE PTAN
ININ1125011OtherMEDICARE PTAN