Emily Lucille Teesdale, A-GNP
Nurse Practitioner, Gerontology in Grand Rapids, MI. Individual provider (NPI-1).
NPI number1982126009
StatusActive
Last updated in NPPESJul 20, 2022
Details
- NPI
- 1982126009
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Emily Lucille Teesdale
- Credential
- A-GNP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 11, 2017
- Certification date
- Jul 20, 2022
- Last updated
- Jul 20, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LG0600X | Nurse Practitioner, Gerontology | 4704274128 | MI | Yes |
Practice location
145 Michigan St Ne Ste 3410Grand Rapids, MI 49503-2563
Phone 616-391-9945
Mailing address
100 Michigan St Ne # Mc845Grand Rapids, MI 49503-2560
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