Healthcare Provider Details

I. General information

NPI: 1073998332
Provider Name (Legal Business Name): CATHERINE LEE TERVOL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 S. MAIN ST.
ONSTED MI
49265
US

IV. Provider business mailing address

217 S. MAIN ST.
ONSTED MI
49265
US

V. Phone/Fax

Practice location:
  • Phone: 517-467-8247
  • Fax: 517-467-8247
Mailing address:
  • Phone: 517-467-8247
  • Fax: 517-467-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704105859
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: