Individual provider · NPI-1

Teresa Altawil, AGPCNP-BC

Nurse Practitioner, Gerontology · Southfield, MI

NPI number1548937162
StatusActive
Last updated in NPPESOct 29, 2025

Details

NPI
1548937162
Entity type
Individual (NPI-1)
Name
Teresa Altawil
Credential
AGPCNP-BC
Sex
Female
Sole proprietor
Yes
Enumeration date
Aug 23, 2021
Certification date
Oct 29, 2025
Last updated
Oct 29, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LG0600X Nurse Practitioner, GerontologyAG05210095MIYes

Practice location

25130 Southfield Rd Ste 120
Southfield, MI 48075-1900

Phone 248-234-6799

Mailing address

20905 Knobs Hollow Dr
Macomb, MI 48044-6326

Phone 586-567-5556

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