Provider Demographics
NPI:1982916946
Name:TEETS, ALVA M JR (CNP)
Entity Type:Individual
Prefix:
First Name:ALVA
Middle Name:M
Last Name:TEETS
Suffix:JR
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2532 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2443
Mailing Address - Country:US
Mailing Address - Phone:614-235-3024
Mailing Address - Fax:
Practice Address - Street 1:2532 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2443
Practice Address - Country:US
Practice Address - Phone:614-235-3024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN312231163W00000X
OHAPRN.CNP.11575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse