Healthcare Provider Details

I. General information

NPI: 1003364696
Provider Name (Legal Business Name): THERESA MARIE CALIHAN MSN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47770 JEFFERSON AVE
CHESTERFIELD MI
48047-2231
US

IV. Provider business mailing address

47770 JEFFERSON AVE
CHESTERFIELD MI
48047-2231
US

V. Phone/Fax

Practice location:
  • Phone: 810-459-7181
  • Fax:
Mailing address:
  • Phone: 810-459-7181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily
License Number4704282994
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: