Provider Demographics
NPI:1164676201
Name:YEARY, NATASHA C (ANP)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:C
Last Name:YEARY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:C
Other - Last Name:GUNDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1481 W. 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-988-4570
Mailing Address - Fax:
Practice Address - Street 1:1481 W. 10TH STREET
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-988-4570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28157133A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health