Healthcare Provider Details

I. General information

NPI: 1942396015
Provider Name (Legal Business Name): CHERYL LYNN SPEIKES ANP, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 WOODLAND DR
INDIANAPOLIS IN
46278-1720
US

IV. Provider business mailing address

7440 WOODLAND DR
INDIANAPOLIS IN
46278-1720
US

V. Phone/Fax

Practice location:
  • Phone: 765-209-1301
  • Fax: 877-836-2060
Mailing address:
  • Phone: 765-209-1301
  • Fax: 877-836-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number28107109A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: