Provider Demographics
NPI:1124013321
Name:BUSS, CHERYL L (NP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:BUSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-0760
Mailing Address - Country:US
Mailing Address - Phone:812-254-7310
Mailing Address - Fax:
Practice Address - Street 1:1805 S SR 57
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4326
Practice Address - Country:US
Practice Address - Phone:812-254-7845
Practice Address - Fax:812-254-5989
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001191A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200535000Medicaid
IN000000390254OtherPMC- ANTHEM
IN000000390254OtherPMC- ANTHEM
IN941140K9Medicare ID - Type Unspecified
IN200535000Medicaid
IN254690BMedicare PIN