Provider Demographics
NPI:1851332654
Name:DITZLER, CHERYL L (CNS)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:DITZLER
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9669 E 146TH ST
Practice Address - Street 2:STE 250A
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-5005
Practice Address - Country:US
Practice Address - Phone:317-621-7740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000089364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00903565OtherRAILROAD MEDICARE PTAN
IN200455400Medicaid
INP00903565OtherRAILROAD MEDICARE PTAN
IN200455400Medicaid
INP15827Medicare UPIN
IN676290QMedicare PIN