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Individual
TERESA LYNN MICOTTO
Active
Individual
TERESA LYNN MICOTTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
29639
NE
207P00000X
Emergency Medicine Physician
Primary
2500098462
MO
2083A0100X
Aerospace Medicine Physician
Primary
29639
NE
Other
Enumeration date
06/11/2015
Last updated
08/25/2026
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