Provider Demographics
NPI:1033957949
Name:TYLER, CHERYL L
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:TYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250A W 86TH ST # 1307
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-3605
Mailing Address - Country:US
Mailing Address - Phone:317-740-4697
Mailing Address - Fax:
Practice Address - Street 1:3250A W 86TH ST # 1307
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3605
Practice Address - Country:US
Practice Address - Phone:317-740-4697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1386383594Medicaid