Provider Demographics
NPI:1861990707
Name:IVATURI, INDIRA (LIFESTYLE COACH)
Entity type:Individual
Prefix:
First Name:INDIRA
Middle Name:
Last Name:IVATURI
Suffix:
Gender:F
Credentials:LIFESTYLE COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6037
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-6037
Mailing Address - Country:US
Mailing Address - Phone:812-235-5555
Mailing Address - Fax:812-234-2700
Practice Address - Street 1:4779 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4559
Practice Address - Country:US
Practice Address - Phone:812-235-5555
Practice Address - Fax:812-234-2700
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator