Teresa Marie Didomenico, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601002779 Issued in MI

Practice address

1504 Sand Point Road
Munising, MI 49862-1406

Phone

(906) 387-4220

Fax

(906) 387-5449

NPI assigned

Aug 30, 2006

Last updated

Feb 19, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235001600000",
    "number": "1114037207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 201",
            "city": "EBEN JUNCTION",
            "state": "MI",
            "postal_code": "498250201",
            "telephone_number": "906-439-5775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1504 SAND POINT ROAD",
            "city": "MUNISING",
            "state": "MI",
            "postal_code": "498621406",
            "telephone_number": "906-387-4220",
            "fax_number": "906-387-5449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIDOMENICO",
        "first_name": "TERESA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2009-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601002779",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5601002779",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI STATE MEDICAL LICENSE",
            "identifier": "5601002779",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Carter, FNP-C
• Myrth Crystal Condon, N.P.
• Tessa L Dagenais, LLMSW
• Christopher Dahlstrom
• Timothy J Derwin, BS
• DL Kolbus Incorporated (Munising Family Chiropractic)
• Miranda Dobbins, LPC
• Hannah M Edmondson, CHW,CPRC,PN
• Bailey Elizabeth Elliott
• Jay H Eppinga, M.D.

• Physician Assistant in Munising, MI
• Providers in Munising, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.