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General NPI Number Information
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NPI Number | 1033506167
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Entity Type | Individual
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Provider Name | HEATHER TEVICH RN, AGPCNP
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Gender | Female
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Dates
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Enumeration Date | 04/15/2015
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 351 W CAMDEN ST
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City | BALTIMORE
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State | MD
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Zip | 21201-7912
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Country | US
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Telephone | 414-852-5954
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Fax |
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Provider Business Mailing Address
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Address Line | 351 W CAMDEN ST
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City | BALTIMORE
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State | MD
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Zip | 21201-7912
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Country | US
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Telephone | 414-852-5954
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 6263
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 135580
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License Number State | WI
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