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NPI Code Detail

MEDICARE: MRS. ALICE M. TEALL CRNP

MEDICARE: MRS. ALICE M. TEALL CRNP
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
1363LF0000XFamily Nurse PractitionerFNP 0346682-22OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487720157
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ALICE M. TEALL CRNP
Provider Business Mailing Address
First Line : 204 PATRICK AVE
Second Line :
City : URBANA
State : OH
Zip : 43078-2302
Country : US
Telephone Number : 937-484-6181
Fax Number :
Provider Business Practice Location Address
First Line : 204 PATRICK AVE
Second Line :
City : URBANA
State : OH
Zip : 43078-2302
Country : US
Telephone Number : 937-484-6181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2006
Last Update Date : 10/13/2014

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