Healthcare Provider Details

I. General information

NPI: 1164676201
Provider Name (Legal Business Name): NATASHA C YEARY ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATASHA C GUNDER RN

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W. 10TH STREET
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

1481 W. 10TH STREET
INDIANAPOLIS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-4570
  • Fax:
Mailing address:
  • Phone: 317-988-4570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number28157133A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: