Provider Demographics
NPI:1154604957
Name:YOUMANS, THERESA LEAH (RN)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:LEAH
Last Name:YOUMANS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10686 29 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-9734
Mailing Address - Country:US
Mailing Address - Phone:517-780-3388
Mailing Address - Fax:517-796-4517
Practice Address - Street 1:10686 29 MILE RD
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-9734
Practice Address - Country:US
Practice Address - Phone:517-780-3388
Practice Address - Fax:517-796-4517
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704242922163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse