Provider Demographics
NPI:1831801430
Name:CRUSE, CHERYL
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:CRUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W 1150 N
Mailing Address - Street 2:
Mailing Address - City:PERRYSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47974-8058
Mailing Address - Country:US
Mailing Address - Phone:217-304-1872
Mailing Address - Fax:
Practice Address - Street 1:1600 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:IN
Practice Address - Zip Code:47932-1715
Practice Address - Country:US
Practice Address - Phone:765-793-4818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28153810A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse