NPIMap

Individual provider Active NPI

Lisa Marie Tetzlaff, FNP-C

  • Family Nurse Practitioner
  • Newberry, MI
National Provider Identifier
1174854400
Registry record updated Jul 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704267555 Issued in MI
Practice address
700 Newberry Ave
Newberry, MI 49868-1503
Phone
(906) 293-3226
Fax
(877) 743-0490
NPI assigned
Jan 27, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 16, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
School Registered Nurse 163WS0200X L1-0037352 DE
Family Nurse Practitioner 363LF0000X 4704267555 MI Primary

Addresses

Primary practice location

700 Newberry Ave
Newberry, MI 49868-1503

Mailing address

9789 W Baird St
Brimley, MI 49715-9291
Phone (906) 203-6042

Other names 1

  • Lisa M Davidson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160311001465 MI Practitioner - Nurse Practitioner 7517263866 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mymichigan Medical Center Sault 101 clinicians

Practice addresses (Care Compare)

509 Osborn Blvd
Suite 320
Sault Sainte Marie, MI 49783-2071
Phone (906) 632-5808

Hospital & facility affiliations

  • Chippewa County War Memorial Hospital Hospital, Sault Ste Marie, MI, CCN 230239
  • Helen Newberry Joy Hospital Hospital, Newberry, MI, CCN 231304

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
L1-0037352DEMDSchool Registered Nurse
4704267555MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Sault Current Accepting new patients
Mymichigan Medical Center Sault CurrentSince Jan 23, 2016 Accepting new patients
Mymichigan Medical Center Sault CurrentSince Jan 23, 2016 Accepting new patients
Luce-Mackinac Health Department Past Accepting new patients

Locations

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

509 Osborn Blvd
Ste 320
Sault Sainte Marie, MI 49783
Phone (906) 322-2210

1138 W 3 Mile Rd
Sault Sainte Marie, MI 49783
Phone (906) 253-0137

500 Osborn Blvd
Sault South Marie, MI 49783
Phone (906) 635-4350

Interoperability endpoints

  • Direct secure messaging: ltetzlaff142397@mymichiganhealth.midirect.net

Organizations & group practices 15

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 15

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1264550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405468800000",
    "number": "1174854400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9789 W BAIRD ST",
            "city": "BRIMLEY",
            "state": "MI",
            "postal_code": "497159291",
            "telephone_number": "906-203-6042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 NEWBERRY AVE",
            "city": "NEWBERRY",
            "state": "MI",
            "postal_code": "498681503",
            "telephone_number": "906-293-3226",
            "fax_number": "877-743-0490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TETZLAFF",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-01-27",
        "last_updated": "2014-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "DE",
            "license": "L1-0037352",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704267555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "DAVIDSON",
            "middle_name": "M",
            "credential": "FNP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Newberry, MI

Sources for this page

Verify at the official NPI Registry.