Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4704282994 | MI |
NPI | 1003364696 |
---|---|
Provider Name | Mrs. Theresa Marie Calihan |
First Address | Chesterfield, MI 48047-2231 |
Second Address | Chesterfield, MI 48047-2231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2016 |
Last Update Date | 13/09/2016 |