Healthcare Provider Details

I. General information

NPI: 1194707448
Provider Name (Legal Business Name): THERESA M DURLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THERESA M DURLEY NP

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 PRESQUE ISLE AVENUE HEALTH CENTER - LOWER GRIES
MARQUETTE MI
49855
US

IV. Provider business mailing address

1401 PRESQUE ISLE AVENUE HEALTH CENTER - LOWER GRIES
MARQUETTE MI
49855
US

V. Phone/Fax

Practice location:
  • Phone: 906-227-2355
  • Fax: 906-227-2332
Mailing address:
  • Phone: 906-227-2355
  • Fax: 906-227-2332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704131080
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704131080
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: