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General NPI Number Information
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NPI Number | 1548937162
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Entity Type | Individual
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Provider Name | TERESA ALTAWIL AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/23/2021
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 25130 SOUTHFIELD RD STE 120
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City | SOUTHFIELD
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State | MI
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Zip | 48075-1900
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Country | US
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Telephone | 248-234-6799
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Fax |
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Provider Business Mailing Address
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Address Line | 20905 KNOBS HOLLOW DR
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City | MACOMB
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State | MI
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Zip | 48044-6326
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Country | US
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Telephone | 586-567-5556
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AG05210095
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License Number State | MI
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