Provider Demographics
NPI:1639710890
Name:TETU, LORI ANN (MSN, RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:TETU
Suffix:
Gender:F
Credentials:MSN, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S BURGESS ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-1403
Mailing Address - Country:US
Mailing Address - Phone:989-343-1367
Mailing Address - Fax:989-343-1427
Practice Address - Street 1:117 S BURGESS ST
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1403
Practice Address - Country:US
Practice Address - Phone:989-343-1367
Practice Address - Fax:989-343-1427
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704177116363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner