Provider Demographics
NPI:1205323086
Name:AKIN, THERESA A
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:AKIN
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 1:20485 GODDARD ST APT 102
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1354
Mailing Address - Country:US
Mailing Address - Phone:313-869-5775
Mailing Address - Fax:
Practice Address - Street 1:20485 GODDARD ST APT 102
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1354
Practice Address - Country:US
Practice Address - Phone:313-869-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7845065372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion