Provider Demographics
NPI:1538694880
Name:ANSTINE, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:ANSTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18914 16 MILE RD
Mailing Address - Street 2:APT B212
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-8797
Mailing Address - Country:US
Mailing Address - Phone:231-832-2247
Mailing Address - Fax:
Practice Address - Street 1:4473 220TH AVE
Practice Address - Street 2:
Practice Address - City:REED CITY
Practice Address - State:MI
Practice Address - Zip Code:49677-8593
Practice Address - Country:US
Practice Address - Phone:231-832-2247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management