Individual
NICOLAS JEAN TERENTJEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
533 E COUNTY LINE RD STE 101, GREENWOOD, IN 46143-1074
(317) 957-9050
Mailing address
533 E COUNTY LINE RD STE 101, GREENWOOD, IN 46143-1074
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
11023196A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300076861
—
IN
Enumeration date
04/03/2023
Last updated
06/21/2023
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