Healthcare Provider Details

I. General information

NPI: 1700691714
Provider Name (Legal Business Name): TERESE A POLING FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2025
Last Update Date: 02/08/2025
Certification Date: 02/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 W HONEY CREEK PKWY
TERRE HAUTE IN
47802-6700
US

IV. Provider business mailing address

858 N LASALLE ST
INDIANAPOLIS IN
46201-2556
US

V. Phone/Fax

Practice location:
  • Phone: 812-234-8733
  • Fax:
Mailing address:
  • Phone: 317-907-4198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberME108693
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number49062
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: