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NPI Code Detail

MEDICARE: DR. YVONNE PATRICIA TEVERBAUGH PHD

MEDICARE:  DR. YVONNE PATRICIA TEVERBAUGH  PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care CoordinatorNONE NECESSARYIN
2175F00000XNaturopathNONE NECESSARYCA
3133N00000XNutritionistUNIV OF CALIFORNACA
4133NN1002XNutrition Education Nutritionist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NONE REQUIREDOTHERINDOCTOR OF NATURAL MEDICNE
2ES29801751OTHERINLICENSED ESTHETICIAN

General Provider Information

NPI Number : 1245354174
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. YVONNE PATRICIA TEVERBAUGH PHD
Provider Business Mailing Address
First Line : 3208 STAMM AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46240-3537
Country : US
Telephone Number : 317-253-3520
Fax Number :
Provider Business Practice Location Address
First Line : 3208 STAMM AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46240-3537
Country : US
Telephone Number : 317-253-3520
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2007
Last Update Date : 07/07/2015

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Directions to “ DR. YVONNE PATRICIA TEVERBAUGH PHD” Practice Location

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