Provider Demographics
NPI:1750362406
Name:TEMPLIN, TERESA (NP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:TEMPLIN
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 1:330 NORTH WABASH AVE
Mailing Address - Street 2:SUITE G20
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2600
Mailing Address - Country:US
Mailing Address - Phone:765-660-7616
Mailing Address - Fax:765-651-7313
Practice Address - Street 1:308 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:IN
Practice Address - Zip Code:46919
Practice Address - Country:US
Practice Address - Phone:765-660-7870
Practice Address - Fax:765-395-5128
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001211A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000321906OtherANTHEM BCBS
IN200420710Medicaid
P41186Medicare UPIN
IN296260UMedicare UPIN