Healthcare Provider Details

I. General information

NPI: 1750362406
Provider Name (Legal Business Name): TERESA TEMPLIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 N JEFFERSON ST
CONVERSE IN
46919
US

IV. Provider business mailing address

330 NORTH WABASH AVE SUITE G20
MARION IN
46952-2600
US

V. Phone/Fax

Practice location:
  • Phone: 765-660-7870
  • Fax: 765-395-5128
Mailing address:
  • Phone: 765-660-7616
  • Fax: 765-651-7313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001211A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: