Provider Demographics
NPI:1598956450
Name:TWEED, CHERYL KIM (NP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:KIM
Last Name:TWEED
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:KIM
Other - Last Name:TWEED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:1210 MEDICAL ARTS BLVD
Mailing Address - Street 2:315
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011
Mailing Address - Country:US
Mailing Address - Phone:765-298-4020
Mailing Address - Fax:765-298-4930
Practice Address - Street 1:1210 MEDICAL ARTS BLVD
Practice Address - Street 2:315
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011
Practice Address - Country:US
Practice Address - Phone:765-298-4020
Practice Address - Fax:765-298-4930
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000282A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP06088Medicare UPIN