Healthcare Provider Details

I. General information

NPI: 1700207081
Provider Name (Legal Business Name): THERESE CAUNT RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2014
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6803 DIXIE HWY STE 2
CLARKSTON MI
48346-5101
US

IV. Provider business mailing address

5022 TIMBERWAY TRL
CLARKSTON MI
48346-4470
US

V. Phone/Fax

Practice location:
  • Phone: 248-625-5143
  • Fax: 866-390-8027
Mailing address:
  • Phone: 248-214-4852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704221485
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: