MEDICARE: MS. LISA TELFER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	22 544400	NY
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	401478	NY
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704401075	MI

General Provider Information

NPI Number	:	1992029524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA TELFER NP

Provider Business Mailing Address
First Line	:	42815 GARFIELD RD STE 210
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1143
Country	:	US
Telephone Number	:	947-208-6467
Fax Number	:

Provider Business Practice Location Address
First Line	:	42815 GARFIELD RD STE 210
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1143
Country	:	US
Telephone Number	:	947-208-6467
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2010
Last Update Date	:	08/16/2025

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