Provider Demographics
NPI:1952396772
Name:KRUEGER, CHERYL (FNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 E 1000 S
Mailing Address - Street 2:
Mailing Address - City:KOUTS
Mailing Address - State:IN
Mailing Address - Zip Code:46347-9730
Mailing Address - Country:US
Mailing Address - Phone:219-766-2167
Mailing Address - Fax:219-879-5900
Practice Address - Street 1:4111 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7803
Practice Address - Country:US
Practice Address - Phone:219-879-5400
Practice Address - Fax:219-879-5900
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN7100349A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100474810Medicaid
IN100474810Medicaid
IN170680SMedicare ID - Type Unspecified