Healthcare Provider Details

I. General information

NPI: 1639427024
Provider Name (Legal Business Name): THERESA SZAKACS HANSEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HOBART ST
CADILLAC MI
49601-2331
US

IV. Provider business mailing address

2000 GREEN ROAD SUITE 300
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-7245
  • Fax: 231-876-7625
Mailing address:
  • Phone: 734-995-3764
  • Fax: 734-686-6354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704132663
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: