Healthcare Provider Details

I. General information

NPI: 1902721947
Provider Name (Legal Business Name): NICHOLAI TEARMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 E US HIGHWAY 36
AVON IN
46123-7366
US

IV. Provider business mailing address

7717 E COUNTY ROAD 200 N
AVON IN
46123-8556
US

V. Phone/Fax

Practice location:
  • Phone: 317-209-8204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number45024382A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: