Healthcare Provider Details

I. General information

NPI: 1851332654
Provider Name (Legal Business Name): CHERYL L DITZLER CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 11/27/2023
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9669 E 146TH ST STE 250A
NOBLESVILLE IN
46060-5005
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-7740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number70000089
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: