Provider Demographics
NPI:1245354174
Name:TEVERBAUGH, YVONNE PATRICIA (PHD)
Entity type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:PATRICIA
Last Name:TEVERBAUGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 STAMM AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3537
Mailing Address - Country:US
Mailing Address - Phone:317-253-3520
Mailing Address - Fax:
Practice Address - Street 1:3208 STAMM AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-3537
Practice Address - Country:US
Practice Address - Phone:317-253-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INNONE NECESSARY171M00000X
CANONE NECESSARY175F00000X
CAUNIV OF CALIFORNA133N00000X
133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175F00000XOther Service ProvidersNaturopath
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INNONE REQUIREDOtherDOCTOR OF NATURAL MEDICNE
INES29801751OtherLICENSED ESTHETICIAN