Provider Demographics
NPI:1588655062
Name:MISHLER, RUTHANN Y (CNMW)
Entity Type:Individual
Prefix:
First Name:RUTHANN
Middle Name:Y
Last Name:MISHLER
Suffix:
Gender:F
Credentials:CNMW
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 2505
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2505
Mailing Address - Country:US
Mailing Address - Phone:812-238-7783
Mailing Address - Fax:812-238-4506
Practice Address - Street 1:1801 N 6TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4086
Practice Address - Country:US
Practice Address - Phone:812-238-7301
Practice Address - Fax:812-238-7056
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN72000007A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200085920Medicaid
IN000000688501OtherANTHEM PROVIDER NUMBER
IN200085920Medicaid
IN941090R6Medicare PIN
IN000000688501OtherANTHEM PROVIDER NUMBER
INQ39502Medicare UPIN
INM400031834Medicare PIN
IN252060D1Medicare PIN