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Individual
MS. THERESA M DURLEY
Active
Individual
MS. THERESA M DURLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704131080
MI
367500000X
Certified Registered Nurse Anesthetist
4704131080
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104654110
—
MI
01
—
44337600
WISC MEDICAID PIN
WI
01
—
TD131080
BLUESHIELD PIN
MI
Enumeration date
11/14/2005
Last updated
02/14/2019
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