Provider Demographics
NPI:1861241937
Name:LESURE, TERISA C
Entity type:Individual
Prefix:
First Name:TERISA
Middle Name:C
Last Name:LESURE
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 1:40118 WINSLOW CT
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-2071
Mailing Address - Country:US
Mailing Address - Phone:313-680-3596
Mailing Address - Fax:
Practice Address - Street 1:40118 WINSLOW CT
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-2071
Practice Address - Country:US
Practice Address - Phone:313-680-3596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist