Provider Demographics
NPI:1841913076
Name:HIATT, TERESA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:HIATT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15945 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-1746
Mailing Address - Country:US
Mailing Address - Phone:517-394-1234
Mailing Address - Fax:517-394-7716
Practice Address - Street 1:15945 WOOD RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-1746
Practice Address - Country:US
Practice Address - Phone:517-394-1234
Practice Address - Fax:517-394-7716
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703090420164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse