Provider Demographics
NPI:1538905567
Name:TASKEY, THERESA ROSE
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ROSE
Last Name:TASKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1046
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49734-5046
Mailing Address - Country:US
Mailing Address - Phone:989-619-1667
Mailing Address - Fax:
Practice Address - Street 1:410 S CENTER AVE APT 1
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1299
Practice Address - Country:US
Practice Address - Phone:989-350-5677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7148416253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care