Provider Demographics
NPI:1700691714
Name:POLING, TERESE A (FNP-BC)
Entity type:Individual
Prefix:DR
First Name:TERESE
Middle Name:A
Last Name:POLING
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 N LASALLE ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-2556
Mailing Address - Country:US
Mailing Address - Phone:317-907-4198
Mailing Address - Fax:
Practice Address - Street 1:70 W HONEY CREEK PKWY
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-6700
Practice Address - Country:US
Practice Address - Phone:812-234-8733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-08
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INME108693163WP0809X
IN49062164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult