Provider Demographics
NPI:1215942024
Name:HESSELL, THERESA MARIE (NP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:HESSELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:MARIE
Other - Last Name:ZEHNDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:44199 DEQUINDRE RD
Mailing Address - Street 2:SUITE 509
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1128
Mailing Address - Country:US
Mailing Address - Phone:248-879-1330
Mailing Address - Fax:248-828-3964
Practice Address - Street 1:44199 DEQUINDRE RD
Practice Address - Street 2:SUITE 509
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1128
Practice Address - Country:US
Practice Address - Phone:248-879-1330
Practice Address - Fax:248-828-3964
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704130174363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI500F318190OtherBCBSM
MI4602614Medicaid