Provider Demographics
NPI:1790966042
Name:PRICE, TEDDI A (NP)
Entity Type:Individual
Prefix:
First Name:TEDDI
Middle Name:A
Last Name:PRICE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5218 BECK DR
Mailing Address - Street 2:SUITE 10
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9121
Mailing Address - Country:US
Mailing Address - Phone:574-522-6102
Mailing Address - Fax:574-295-3928
Practice Address - Street 1:5218 BECK DR
Practice Address - Street 2:SUITE 10
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-9121
Practice Address - Country:US
Practice Address - Phone:574-522-6102
Practice Address - Fax:574-295-3928
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28064537A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health