Provider Demographics
NPI:1710262308
Name:RIWITIS, CHERYL LYNN (NP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:RIWITIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:HEATHERLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:950 N. MERIDIAN STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204
Mailing Address - Country:US
Mailing Address - Phone:317-962-4942
Mailing Address - Fax:317-962-4950
Practice Address - Street 1:2401 W. UNIVERSITY AVE.
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3428
Practice Address - Country:US
Practice Address - Phone:765-747-3241
Practice Address - Fax:765-281-6567
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28088897163W00000X
IN71003761363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201040610Medicaid
INM400057892Medicare PIN