Provider Demographics
NPI:1417581497
Name:PFAFF, TERESA (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:PFAFF
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4995 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-1143
Mailing Address - Country:US
Mailing Address - Phone:313-886-3300
Mailing Address - Fax:
Practice Address - Street 1:4995 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1143
Practice Address - Country:US
Practice Address - Phone:248-767-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704304045363LF0000X
MI4704304045NSA2004G363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily