Provider Demographics
NPI:1417916826
Name:SPROULE, TERAH ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:TERAH
Middle Name:ANN
Last Name:SPROULE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TERAH
Other - Middle Name:ANN
Other - Last Name:SCHERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:2600 FERRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3055
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001115A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN9397651OtherPHCS PID NUMBER
IN200336300Medicaid
IN000000235990OtherANTHEM PROVIDER NUMBER
IN500018630Medicare PIN
IN142080TTTMedicare PIN
IN9397651OtherPHCS PID NUMBER
IN815500K8Medicare PIN
IN200336300Medicaid