Provider Demographics
NPI:1639178015
Name:DULTMEIER, CHERYL M (APRN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:M
Last Name:DULTMEIER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:DEPT CH 14389
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60055-4389
Mailing Address - Country:US
Mailing Address - Phone:785-295-8108
Mailing Address - Fax:785-231-5991
Practice Address - Street 1:634 SW MULVANE ST
Practice Address - Street 2:SUITE 209
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1678
Practice Address - Country:US
Practice Address - Phone:785-295-5330
Practice Address - Fax:785-295-5355
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS44923363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP10476Medicare UPIN