MEDICARE: CHERYL LYNN DITZEL CRNP, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP014423	PA

General Provider Information

NPI Number	:	1740686633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL LYNN DITZEL CRNP, FNP-BC

Provider Business Mailing Address
First Line	:	630 FAIRVIEW RD
Second Line	:	SUITE 210
City	:	SWARTHMORE
State	:	PA
Zip	:	19081-2334
Country	:	US
Telephone Number	:	610-541-0155
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 FAIRVIEW RD
Second Line	:	SUITE 210
City	:	SWARTHMORE
State	:	PA
Zip	:	19081-2334
Country	:	US
Telephone Number	:	610-541-0155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/05/2014

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