Provider Demographics
NPI:1346765344
Name:VANDEHEY, THERESA L (FNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:VANDEHEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:L
Other - Last Name:MUNOZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15741 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1193
Mailing Address - Country:US
Mailing Address - Phone:313-588-0026
Mailing Address - Fax:
Practice Address - Street 1:7445 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1963
Practice Address - Country:US
Practice Address - Phone:313-388-9552
Practice Address - Fax:313-789-7620
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015830363L00000X
MI4704337222363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner