Provider Demographics
NPI:1821683434
Name:SCOFIELD, THERESA LOUISE
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:LOUISE
Last Name:SCOFIELD
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 1:11280 HILLMAN RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48850-9170
Mailing Address - Country:US
Mailing Address - Phone:989-400-0189
Mailing Address - Fax:
Practice Address - Street 1:11280 HILLMAN RD
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850-9170
Practice Address - Country:US
Practice Address - Phone:989-400-0189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703098899164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse