Provider Demographics
NPI:1306196340
Name:KRIDLER, SHERYL
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:KRIDLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 GLENRUADH AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-1731
Mailing Address - Country:US
Mailing Address - Phone:816-585-2289
Mailing Address - Fax:
Practice Address - Street 1:2185 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4747
Practice Address - Country:US
Practice Address - Phone:814-464-8311
Practice Address - Fax:814-464-8462
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012029010363LP0808X
MO2012033115363LP0808X
PASP017036363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health