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General NPI Number Information
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NPI Number | 1952396772
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Entity Type | Individual
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Provider Name | CHERYL KRUEGER FNP
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Gender | Female
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 12/17/2013
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Provider Practice Location Address
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Address Line | 4111 FRANKLIN ST
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-7803
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Country | US
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Telephone | 219-879-5400
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Fax | 219-879-5900
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Provider Business Mailing Address
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Address Line | 461 E 1000 S
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City | KOUTS
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State | IN
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Zip | 46347-9730
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Country | US
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Telephone | 219-766-2167
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Fax | 219-879-5900
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 7100349A
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License Number State | IN
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