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
1	171M00000X	Case Manager/Care Coordinator	NONE NECESSARY	IN
2	175F00000X	Naturopath	NONE NECESSARY	CA
3	133N00000X	Nutritionist	UNIV OF CALIFORNA	CA
4	133NN1002X	Nutrition Education Nutritionist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NONE REQUIRED	OTHER	IN	DOCTOR OF NATURAL MEDICNE
2	ES29801751	OTHER	IN	LICENSED 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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