Provider Demographics
NPI:1154438745
Name:LABRANCHE, THERESA LYNNE (MS PA C)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNNE
Last Name:LABRANCHE
Suffix:
Gender:F
Credentials:MS PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WALNUT BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2056
Mailing Address - Country:US
Mailing Address - Phone:586-651-2155
Mailing Address - Fax:248-413-5841
Practice Address - Street 1:211 WALNUT BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2056
Practice Address - Country:US
Practice Address - Phone:586-651-2155
Practice Address - Fax:248-413-5841
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002721363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical