Provider Demographics
NPI:1801407606
Name:TEASTER, DIANA FRANCES (NP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:FRANCES
Last Name:TEASTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20056 LEZOTTE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48173-8621
Mailing Address - Country:US
Mailing Address - Phone:734-787-9229
Mailing Address - Fax:
Practice Address - Street 1:107 APRILL DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-1956
Practice Address - Country:US
Practice Address - Phone:734-212-6891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704254078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily