Provider Demographics
NPI:1184832792
Name:YELLE, TERESA KAREN (MSN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:KAREN
Last Name:YELLE
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PERIDOT ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-5198
Mailing Address - Country:US
Mailing Address - Phone:970-619-4580
Mailing Address - Fax:970-619-4589
Practice Address - Street 1:200 PERIDOT ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5198
Practice Address - Country:US
Practice Address - Phone:970-619-4580
Practice Address - Fax:970-679-4589
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO140265363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57108064Medicaid
CO51708064Medicaid