Provider Demographics
NPI:1194707448
Name:DURLEY, THERESA M (NP)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:M
Last Name:DURLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:M
Other - Last Name:DURLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1401 PRESQUE ISLE AVENUE
Mailing Address - Street 2:HEALTH CENTER - LOWER GRIES
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-227-2355
Mailing Address - Fax:906-227-2332
Practice Address - Street 1:1401 PRESQUE ISLE AVENUE
Practice Address - Street 2:HEALTH CENTER - LOWER GRIES
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-227-2355
Practice Address - Fax:906-227-2332
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704131080367500000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104654110Medicaid
WI44337600OtherWISC MEDICAID PIN
MITD131080OtherBLUESHIELD PIN