Provider Demographics
NPI:1891222808
Name:CURNYN, TESS LACIE (DO)
Entity Type:Individual
Prefix:
First Name:TESS
Middle Name:LACIE
Last Name:CURNYN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TESS
Other - Middle Name:LACIE
Other - Last Name:EDVARDSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:52500 FIR RD
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:52500 FIR RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8579
Practice Address - Country:US
Practice Address - Phone:574-271-0700
Practice Address - Fax:574-273-5648
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INPENDING207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
INPENDINGOtherSTATE LICENSE