Healthcare Provider Details

I. General information

NPI: 1225662448
Provider Name (Legal Business Name): AMELIA H TEAS DNP APRN AG/ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 89TH AVE
MERRILLVILLE IN
46410-7318
US

IV. Provider business mailing address

2225 KELLE DR APT 202
CHESTERTON IN
46304-8744
US

V. Phone/Fax

Practice location:
  • Phone: 219-738-4926
  • Fax: 219-738-4931
Mailing address:
  • Phone: 815-954-8327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number8845473-8900
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: