Provider Demographics
NPI:1003379306
Name:ANTONY, TREESA (DNP, FNP-BC, RN-BSN)
Entity Type:Individual
Prefix:DR
First Name:TREESA
Middle Name:
Last Name:ANTONY
Suffix:
Gender:F
Credentials:DNP, FNP-BC, RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5285 ANTHONY WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3947
Mailing Address - Country:US
Mailing Address - Phone:248-880-7283
Mailing Address - Fax:
Practice Address - Street 1:700 REYNOLD SWEET PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1816
Practice Address - Country:US
Practice Address - Phone:248-437-2048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704310872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily